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Club Membership Form
Nameyour full name
Pan Noyour full name
Mobileyour full name
Addressmore details
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Occupationyour full name
DOBof appointment
Statuspick one!
Qualificationyour full name
Life Membership Applied for Self /coupleyour full name
Reffered By Whomyour full name
Do you drink wine at homepick one!
Are You a Veg/Non Vegpick one!
Ready to learn wine Making at homeyour full name
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