Madhesh Human Rights (Madhur)

Membership Form (Madhur)

INFORMATION OF THE APPLICANT

1. Personal Details

Your Name as it appears on your passport

First Name (required)

Middle Name

Last Name (required)

Gender (required)

Nationality (required)

Date of Birth (required)

Place of Birth (required)

Married (required)
YesNo

Spouse Name

Highest Education (required)
SchoolBachelor DegreeMaster DegreePhD

Profession and Occupation (required)

Mailing Address

Street Address (required)

Address Line 2

City (required)

State (required)

Zip (required)

Your Email (required)

Telephone (with country and city codes) (required)

2. Have you even been convicted in court? If yes, provide details.(required)
YesNo

3. Are you currently executive member of any other Not-for-profit (nonprofit) organization? If yes, provide details. (required)
YesNo

4. Were you executive member of any Not-for-profit (nonprofit) organization in past 2 years? If yes, provide details. (required)
YesNo

5. Why do you want to join Madhesh Human rights (MADHUR)? (Please write in not more 200 words). (required)

6. What Madhesh Human rights (MADHUR) should be doing? (Please share your idea). (required)

7. Upload your passport photo (max 2MB) (required)

7. Do you commit to work within the charter of Madhesh Human Rights (MADHUR)? (required)
YesNo

Signature (sign using mouse or finger) (required)

Today's Date (required)