Your Name (required)

Your Gender(required)

Your District(required)

Palika (Municipality/Gaupalika) (required)

Age (required)

Occupation (required)

Your Email (required)

Phone (required)

Facebook/twitter or any social media link of you or your group

Are you associated with any organization? YesNo

Why do you want to be part of the campaign? (required)

Are you joining the movement as part of your group/organization or an individual?

Please explain your detail plan with your timeline to start the movement

Have you ever led or been part of any social movement/campaign or voluntary work? If yes briefly explain

Any other thing you want us to know more about you