1/3/14 | Aam Aadmi Party, India

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MEMBERSHIP FORM
Form Number : 9000807339 Date : 03 Jan 2014
State : MAHARASHTRA District : RAIGAD
Name : Mr.Prem singh deepak
Father's Name : RAM SHARAN DEEPAK
Age (in Years) : 47
Address :
204 NAVRESIDENCY, NEAR SAWTAMALI HALL OLD PANVEL
NEW MUMBAI
Mobile Number : 9004411953
Email ID : DEEPAKKANCHA@GMAIL.COM
Democracy is popular self rule, but the current practice of democracy negates this ideal and
reduces the citizens to mere subject. Aam Aadmi Party aims to restore power to the people, so as
to realize the promise of Swaraj enshrined in our constitution.
"I am a Citizen of India. I am above 18 years of age. I am not a member of any political party. I
believe in the objectives and thinking of the party and I am willing to fully participate in achieving
the objectives of the party."
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( 1H / Applicants Signature)
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q - Ground floor, A-119, Kaushambi, Ghaziabad, UP, 201010.
Submit this printout along with a postal order of Rs.10/- at the party office of your city OR send
the printout and postal order to our national office at - Ground floor, A-119, Kaushambi,
Ghaziabad, UP, 201010.
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We have not authorized any individual to collect money on behalf of the Party. In case you send
the form through someone else, please do it through a trusted person only.
www.aamaadmiparty.org | 09718500606 | contact@aamaadmiparty.org
www.facebook.com/AamAadmiParty | Twitter : @aamaadmiparty
Office of the Aam Aadmi Party,
Ground floor, A-119, Kaushambi, Ghaziabad, UP, 201010.
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