Sub : Seeking Membership to Bahujan Sena (BS)

I am citizen of India. I am above 18 years. I am not a member of any other political party registered with the Election Commission of India. I am not a member with any organization whose views, policies or actions are in conflict with the objective of the Bahujan Sena (BS). I have not been convicted of any offense involving moral turpitude. I have full faith of party's objective and vision.

I shall bear true faith and allegiance to the Constitution of India as; by law established and to the principles of socialism, secularism and democracy and would uphold the sovereignty, unity and integrity of India.

I hereby consent to receiving any communication from Bahujan Sena (BS) or the party either in writing, electronically and/or in any audio-visual format via phone (including SMS/MMS), email and/or at my address. The particulars and statements made hereunder are correct to the best of my knowledge and nothing has been concealed or withheld. I request you to admit me as Bahujan Sena (BS) member. I render information related to my membership as under

Name *
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Date of Birth
State *
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Vidhan Sabha Constituency *
Mandal or Block *
Municipal Ward/Gram Panchayat *
House Number
Pin Code / Zip Code
Voter ID Number
Mobile Number
Email ID
Whether belongs
Would you want to volunteer Yes No