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Membership Form    Name: _________________________________  Date of Birth: ____________________________    Address: _________________________________________________________________________    _________________________________________________________________________________    Telephone: ______________________________  E‐mail: _________________________________    Occupation/Course: _______________________  Company /School: ________________________    Skills: ____________________________________________________________________________    Languages [speak/read/write]: _______________________________________________________    Areas of Interest (check all that apply):      Education   Publicity/Recruitment   Sanitation 

Legal 

Healthcare/Health Education 

Microfinance/Microeconomics

Vocational Training 

Other: ______________________ 

Can we contact you for planning/development/administration work?     Yes   No    Do you have any comments/questions?      _________________________________________________________________________________    _________________________________________________________________________________    Date: ____________________  Signature: ______________________________    Thanks for joining the team!  web: www.sangamindia.org  email: info@sangamindia.org 

Copyright © 2009 Sangam India  Sangam India is a Non Profit Organization 

Registration Form  

Sangam India Registration Form

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