Membership Form

Dear Publishers fill this form and upload your Photograph, Resident Proof,ID Proof and RNI Certificate. We will confirm your membership by email with in 24 hour.You can fill multiple form for your multiple Publications. Members of LIPA are eligible to get Office Support, Advertisement and Marketing Support, Audit assistance, Technical assistance and Documentary assistance.

Name of Publisher. *

Name of Newspaper. *

RNI Number *

Publication State *

Publication Language *

Periodicity *

Email Id. *

Website, If any *

Write website or blog Address here.

Sex *

Male  Female

Date of Birth. *

DD / MM / YYYY

Mobile *

Phone Number *

Why you want to join the LIPA? *

To strengthen my newspaper. To get advertisement for my newspaper. To get technical support for my newspaper. To get documentary support for my newspaper. To get office for my newspaper. To get audit support for my newspaper.

How do you know about the LIPA? *

By friend. By letter. By newspaper Advertisement . By Hoarding Advertisement . By website/search engine/ social networking site etc. By email. By personal communication.

Upload Your Documents in Given Category.

Upload Your Photograph: *

Passport Photograph: Do not wear a hat or headgear that obscures the hair or hairline. Size of photograph should not excide more than 150KB.

Upload your RNI Certificate: *

RNI Certificate: Scan copy of RNI certificate, text should be readable in scan copy. Size should not excide more than 150KB.

Upload Your ID Proof: *

ID Proof: PAN card, Voter ID card, Passport, Driving license, Ration card (any of these). Size should not excide more than 150KB.

Upload Your Resident Proof: *

Resident Proof: In case your ID proof does not have your address on it than attach Electricity bill, Telephone bill, RC copy of vehicle, Registered rent agreement, Bank passbook. Size should not excide more than 150KB.

References:  Name

Address

Phone

I certify that information contained in this application is true and complete. I understand that false information may be grounds for immediate termination of submission at any point in the future if I am hired. I authorize the verification of any or all information listed above.

Do you agree with the terms and conditions? *

Yes, I agree.

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