Joining the network – CBID International Consortium

CBID International Consortium

Basic Details of the organization

NEW MEMBERSHIP FORM

MEMBERSHIPS APPLICATION FORM

Organizatoin Name

Organization Logo

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Short Abbreviation of Organization

Date of establishment

Registration No

Office Address

Category of Organizaton

Country of Registration

Registration under Law

Purposes and Outreach

Vision/Goals of Orgnaization

Thematic areas

Working Geographical Areas

Country

District/County

Sub District

Province/State

City

Union Council

Details of Memberships (i.e Govt Committees, Affiliations/Certifications with other Netwrok/Forums)

Name of Network or Forum

Name of Network1

Name of Network2

Name of Network3

Name of Network4

Name of Founder organization

Founder organization1

Founder organization2

Founder organization3

Founder organization4

Memebership Start Date

Date / Time1

Date / Time2

Date / Time3

Date / Time4

Current Status

Current Status1

Current Status2

Current Status3

Current Status4

Contact Information

Name

Name1

Name2

Designation

Designation1

Designation2

Cell No

Phone/Mobile1

Phone/Mobile2

E.mail

Email1

Email2

Impairment

Impariment

Yes

if yes, What Category:

Address and Contacts (Main office/ Head office)

Type of office

District

Website

(Landline /Mobile)

Declaration by the organization:

I, the undersigned being the person responsible in the organization certified that the information given in this application are correct.

I, the undersigned and our organization must adhere values, culture, code and ethics of CBID International Consortium inspired from UNCRPD

Respect to humanity and dignity

Respect to diversity and inclusion

Learning Sharing

Core Humanitarian Principals

Discourage Discrimination and exclusion

The organization is agreed with CBID Consortium international's vision, mission, objectives, TORs and by-laws

Name

E-Sign Upload

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Address Line 1

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