*Name  
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 *Street  
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 *Pin  
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 *E-mail  
 Web-site  
 *Profession  
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 *I want to know more of the activities Arogya   Sandhan  
 *I want to know more the project “Child and Mother   Care Hospital”  
 *I want to be a Member  
 *I want to register my name as voluntary Blood Donor  
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 *I want to adopt a thalassemic child  
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*These fields must be filled up by the Applicant.

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