2. Address : ……………………………………………………………………………………..………………………………………………………………………..………………
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Tel
: …………………..………………………….….…………………..…………………………………………………………………………………..
Fax : ………………………………………………………………………………..……………………………………………………..…………….……
E-mail : …………………………………………………….………… Website : …………………………………..…….………..….………..
3. Founded
in (year) : ……………………………………….: by
: ………………………………………………………………….……….……………………………
4. Number
of members : …………………………………………………………………………………………………….……………………….……………….………..
5. Nature of Membership : .……………………………………………………………………………………………………………………….……………………………
6. Are
you in anyway affiliated with, controlled by or controlling any other organization? If
answer is YES, please explain in detail:
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7. Are
you registered with the Government ? If
so, give full details :
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8. Officers
(state if elected and for how long) :
1. Position …………………………………………………………………………………………………………………………… year(s) ……….…….………………..
2. Position …………………………………………………………………………………………………………………………… year(s) ……..………………………..
3. Position …………………………………………………………………………………………………………………………… year(s) ………..……………………..
4. Position …………………………………………………………………………………………………………………………… year(s) ……..………………………..
5. Position …………………………………………………………………………………………………………………………… year(s) ……………..………………..
6. Position …………………………………………………………………………………………………………………………… year(s) ………………..……………..
7. Position …………………………………………………………………………………………………………………………… year(s) ………..……………………..
8. Position …………………………………………………………………………………………………………………………… year(s) ……..………………………..
9. Position …………………………………………………………………………………………………………………………… year(s) ……………..………………..
10. Position …………………………………………………………………………………………………………………………… year(s) ………………..……………..
9. Objects
and Activities (including publications) : …………………………………….………………………………………………………………….
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10. References
: ………….…………………………………………………………………………………………………………………….…………………………………………
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11. A
Balance Sheet of (date)
: ………………………………………..…………………………………………………………………………….
is included.
Signed …………………………………………………………………………..
( …………………………………………………………..………….)
Title …………………………………………………………………………..
Date …………………………………………………………………………..