Membership form

1. Name …………………………………………

2. Psychical status Blind ……… ……….. ……….

3. Date of birth …………………… v.s …………… Date

Place
Country

4. Blood group

5. Health

6. Citizenship No. Issued place Date

7. Passport No. Issued place Date

Expiry date

8. Gender Other Female Male

9. Marital status Divorce Widow Single Double

10. Family

11. Financial situation

12. Bank account

 13. Professions

14. Detail contact

15. Urgent contact

16. Hobbies

17. Travels Nepal - ……………..

18. Skill

19. Limitations

20. Training

21. I know

22. I can do

23. I can give Hours Days Weeks

Date Thumb or Signature

15 Ashad 2063 v.s
29th June 2006