(Fields marked * are mandatory !)

 
 
   
Date Of Birth*  
 
   
I want to be a Volunteer for the Association
Yes:

Next Of Kin in case of Grievance


Domicile Address in Himachal Pradesh

 
 
 
Any other address out of Himachal Pradesh

I confirm that the above given information is best of my knowledge and I acknowledge that the website https://www.himachali-seafarers.com contains the required information in connection to its services. I also confirm by checking this disclaimer box, it will be deemed that I have read and understood the privacy policy of the association. I will be responsible if any above entered information is not correct and the association bears all the rights to cancel or inactivate my membership without any prior notice.