Directory Information Form

Name: *

Call Name: *

Year of Governorship: *

Classification : *

RI District: *

Home Club:

Name of Spouse:

Address line 1: *

Address line 2:

City: *

State: *

Pincode: *

Birthday (Self): *

Date:

Month:



 
Birthday (Spouse):

Date:

Month:



Wedding Anniversary:

Date:

Month:




Phone number (with STD code):

Mobile number: *

Email: *

Your photograph [Max: 2MB]: *

Spouse photograph [Max: 2MB]:



Remarks (if any):

*fields are required

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