Member ID Card Information Form

Please provide accurate and current information for the BASAVA member database and official Member ID Card preparation.

Member Details

Fields marked with * are required. Please upload a clear recent photograph.

1. Basic Information

Full Name (with Dr.) *

Write your name exactly as you want it printed on the ID card.

Blood Group *

Email Address *

Mobile Number *

BVC Reg. No. *

BASAVA Membership No. *

Category

2. Address & Workplace

Present Address *

Permanent Address *

Present Workplace *

Designation *

3. Member Photograph

Photo Preview

Picture *

Recent passport-style photo preferred
JPG, PNG or WebP
Maximum 3 MB
Clear face and clean background

4. Declaration

I confirm that the information provided above is correct and may be used by BASAVA for its official member database, membership verification and Member ID Card preparation. *

Your information will be reviewed by an authorized BASAVA administrator before your membership is marked Active Member.