APCR West Bengal | Membership Application Form

1

Personal Information

Full Name (আবেদনকারীর পুরো নাম) * Please enter your full legal name.

Date of Birth (জন্ম তারিখ) * Must be at least 18 years old to join as a voting member Please select a valid date of birth.

Gender (লিঙ্গ)

Father's / Spouse's Name

2

Contact & Jurisdiction (District)

Mobile Number (মোবাইল নম্বর) * This number will be used for official communication and updates Please enter a valid 10-digit mobile number.

Email Address (ইমেল) Please enter a valid email address.

District of West Bengal (জেলা) * Please select your district in West Bengal.

Sub-Division / Police Station (থানা)

Full Residential Address (ঠিকানা)

PIN Code (পিন কোড)

3

Educational Qualification & Profession

Highest Educational Qualification (শিক্ষাগত যোগ্যতা) * Please select your highest qualification.

Field of Study / Specialization

Current Profession / Occupation (পেশা)

Bar Council Reg. No. / College / Organization (If any)

4

Areas of Interest in APCR (আগ্রহের ক্ষেত্র)

Select the areas where you would like to actively contribute as an APCR member/volunteer:

Legal Aid & Free Litigation Support Fact-Finding & Ground Documentation RTI, Legal Literacy & Public Workshops Youth & University Wing Outreach Press, Media & Digital Advocacy Victim Relief & Community Support

Declaration & Pledge: I hereby declare that the particulars provided above are true to the best of my knowledge. I believe in democratic values, the Constitution of India, and human rights. I express my willingness to join the Association for Protection of Civil Rights (APCR) West Bengal chapter and abide by its constitution and working principles.

You must agree to the pledge to submit your application.

Association for Protection of Civil Rights (APCR)

West Bengal Chapter | পশ্চিমবঙ্গ রাজ্য অধ্যায়

Application Successfully Submitted!

Personal Information

Contact & Jurisdiction (District)

Educational Qualification & Profession

Areas of Interest in APCR (আগ্রহের ক্ষেত্র)