Himachal Pradesh
State Disaster Management Authority
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Volunteer Registration
Name
Gender
Male
Female
Other
Date Of Birth
Blood Group
Select
O+
O-
A+
A-
B+
B-
AB+
AB-
Fathers Name
Mothers Name
Address
Distt
----- Select -----
BILASPUR
CHAMBA
HAMIRPUR
KANGRA
KINNAUR
KULLU
LAHAUL AND SPITI
MANDI
SHIMLA
SIRMAUR
SOLAN
UNA
PinCode
PhoneNo
Mobile
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(In Chronological Order)
Qualification
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Passing Year
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Post Graduation
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Matric
Intermediate
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Post Graduation
Doctorate
Other
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Matric
Intermediate
Graduation
Post Graduation
Doctorate
Other
Select
Matric
Intermediate
Graduation
Post Graduation
Doctorate
Other
Prior Experience/Expertise in Disaster Management Related Activity
(If any)
Disaster-Specific Area You Want to Get Trained in
(Select the Suitable One)
Medical First Aid
Search & Rescue
Relief
Psychosocial Care
Other
Emergency Contact Person Details
(This must be a Family Member, Guardian or a Close Relative)
Name
Address
PinCode
PhoneNo
Declaration
(To be filled in by the applicant only)
I, hereby declare that I am keen to become a volunteer for HPSDMA and want to render selfless services for effective disaster management. By submitting this form, I declare that all the information provided by me in this form is true, correct and complete. Date:
07/12/2024
Place:
Security Code
[case-sensitive]