(A society registered under the Societies Registration Act, 1860)

ANNUAL MEMBERSHIP FORM Personal details (Please fill the form in English, in BLOCK LETTERS only) Name : First Name Surname Call Address . Taluk/Mandal District . Pin Code : Mobile: . Phone/Fax [Code]: 0- Email ID :@... Date of registration [Company/Society] [hectares or Age: __________years _________________ State : Name : .. Middle Name

Mr/Ms/Dr.

Total area of Land/Farm: ________________ acres/bighas/guntas]

Crops grown : ________________________________________________________

I/We qualify to be a member of the Association under the following categories (please tick the chosen category/categories): a) Organic Farmer b) Organic Consumer c) Organic Farming Promoter [Fee Rs. 100/- p.a. as individuals. Pay for up to ten years in advance.] d) Society/Trust/Producer company for organic food production [Fee Rs.1000/- p.a] e) Green Shop / Green Trader [Rs.1000/- p.a] f) Partnership/Private Company (producers/suppliers of organic farming inputs and organic produce) [Fee Rs.5000/- p.a] I/We desire to become a member of the Organic Farming Association of India and I/we agree to abide by the Rules and Regulations to further the aims and objects of the association. My/Our membership fee is enclosed herewith by DD/Cheque on Par/ Cash/ M.O./P.O. in favour ofOrganic Farming Association of India.

I am willing to assist the Association in the furtherance of its objectives by

________________________________ Name and signature of applicant Membership can be deposited directly in AXIS Bank SB A/c 180010100029917 payable at Mapusa and the form sent as FAX, email attachment or post to:
OFAI Central Secretariat G-8 St.Britto's Apartments. Feira Alta, Mapusa, Bardez. Goa-403 507 Ph: 91 832 2255913 Fax: 2263305 Email: myofai@gmail.com Contact: Miguel/Rashmila/Jenessey INDIA