Registration Form

Membership Application Form

Full Name*
Email
Mobile*
Blood Group
Unit (District)*
Profile Photo (jpg/png/webp, < 3MB)*
Father's Name

Gender

Male Female Other

Date of Birth
Media Organization
Address
Mandal / Town
Pincode
Press ID Number
Experience (years)
Area of Coverage
Reference Person (if any)
ID Proof (image/pdf)
I hereby declare that the above information is true to the best of my knowledge.