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Member Registration Form

(All the fields which are marked by * are mandatory)
Type of the organisation * :
Name of the Individual / organisation * :
Address * :
City * :
Pin code * :
Telephone number * :
Fax number * :
Email address *  
Website if any :
Name & Designation of Head of the organisation * :
Mobile number of Head * :
Name of Head Vocational Unit / Coordinator for ARUNIM * :
Phone Number of Coordinator * :
Email Id of Coordinator * :
Registration Number with National Trust :
Society Registration Number :
ARUNIM’s Registration Number
(in case of re-registration)
:
Nature of Disabilities of Members *
(Tick all that are applicable)
:



Product

Product (including agro based products) :
No. of persons with National Trust disabilities employed :
No. of persons with other disabilities employed :
No. of nondisabled employed :
Av. No. units made per month :
Av. No. working hrs of the unit :
Av. Salary / Stipend earnings per month per disabled person involved Rs. :
How it is sold :
       
  • Bank Details
     *
    +

    DD No * :
    Bank * :
    DD Date * : calendar

  • Services (i.e. Urban, Rural or Trading)
     
    +

    Service Name :
    No. of persons with National Trust disabilities employed :
    No. of persons with other disabilities employed :
    No. of nondisabled employed :
    Av. No. units made per month :
    Av. No. working hrs of the unit :
    Av. Salary / Stipend earnings per month per disabled person involved Rs. :
    What are your Marketing Strategies :
           

  • What are the problems faced in sheltered workshops / Enterprise run by you?
     *
    +

    (Tick all that are applicable)










  • How would you like ARUNIM to help you?
     *
    +

    (Tick all that are applicable)










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