User Registration Form User Registration Personal Details First Name * Last Name * Mobile Number * Email Address * Enter Email Password * Enter Password Confirm Password * Confirm Password Address in Nepal Were you born, migrated or associated with Chitwan district in Nepal? * Yes NoNo Municipality / Rural Municipality * Bharatpur Metropolitan City Kalika Municipality Khairahani Municipality Madi Municipality Ratnanagar municipality Rapti Municipality Ichchhakamana Rural Municipality OtherOther Address in Australia Address * Address Line 1 (Unit / Apartment / House No & Street Name) Suburb * Post Code State * NSWACTTASNTWAQLDSAVIC Membership Membership Type Student - $10.00Adult - $20.00Couple / Partner - $30.00Life Member - $100.00 Please upload student ID * Drop a file here or click to upload Choose File Maximum file size: 516MB Couple / Partner First Name * Last Name * Email * Thank you for your interest in supporting Chitwan Samaj Australia. You can contribute to our cause by making a donation to our CSA PayPal account. Your generous support will be gratefully acknowledged on our website as a part of our list of supporters. Register
