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First Name *

Middle Name 

Last Name *

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Date Of Birth

Nationality*

Present Positon

Name Of the Organization

Address

Present Contact Address:

District * Select Your District Achham Arghakhanchi Baglung Baitadi Bajhang Bajura Banke Bara Bardiya Bhaktapur Bhojpur Chitwan Dadeldhura Dailekh Dang Darchula Dhading Dhankuta Dhanusa Dholkha Dolpa Doti Gorkha Gulmi Humla Ilam Jajarkot Jhapa Jumla Kailali Kalikot Kanchanpur Kapilvastu Kaski Kathmandu Kavrepalanchok Khotang Lalitpur Lamjung Mahottari Makwanpur Manang Morang Mugu Mustang Myagdi Nawalparasi Nuwakot Okhaldhunga Palpa Panchthar Parbat Parsa Pyuthan Ramechhap Rasuwa Rautahat Rolpa Rukum Rupandehi Salyan Sankhuwasabha Saptari Sarlahi Sindhuli Sindhupalchok Siraha Solukhumbu Sunsari Surkhet Syangja Tanahu Taplejung Terhathum Udayapur

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