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Name	Email	Mobile Number	Role	District	Taluk	Village	Part	Active	Actions

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Name Please enter your name.

Email Please enter a valid email address.

Mobile No* Please enter a valid 10-digit mobile number.

Select Role Please select a role.

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Please select at least one District.

Select Taluk Please select at least one Taluk.

Select Village Please select at least one Village.

Select Part Please select at least one Part

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