APPLICATION FORM FOR
MEMBERSHIP
ACTION FOR PROTECTION OF WILD ANIMALS (APOWA)
At-Hatapatana,
Po-Kadaliban, Dist-Kendrapara, Orissa, Pin-754222,
Telephone-06729
221908, E mail- apowa1999@yahoo.co.in,
Website- www.apowa.org
[RECOGNISED BY AWBI, MINISTRY OF ENVIRONMENT &
FORESTS, GOVT OF
Space for Photo
1.Name: ___________________________________________________________
2.Mailing
address: _____________________________________________________
____________________________________________________________________
3. Telephone No: _____________________________________________________
4. Mobile No: ________________________________________________________
5. E-mail: ___________________________________________________________
6. Date of Birth: ______________________________________________________
7.Occupation: ________________________________________________________
8.Profession: _________________________________________________________
9. Organization/Position: _______________________________________________
10. Vegetarian/Non-Vegetarian: __________________________________________
11. Please list any other Organization that you are
member of __________________
12. Why you want Joining APOWA_____________________________________________________
__________________________________________________________________________________
13.Type of Membership: ______________________________________________________________
(a)
Student Rs 10/- (b) Youth Rs 50/- (c) Others Rs 100/- (d) Life member Rs 1000/-
(e)
Patron Rs 5000/-
Signature
& Date
FOR OFFICE USE
Application placed before the managing committee
meeting held on___________and application accepted/rejected.
Membership No:
Membership Type:
N.B-Kindly send this form along
with one stamp size photo, to Secretary APOWA, At-Hatapatana, Po-Kadaliban
Dist-Kendrapara, Orissa,
Pin-754222
MEMBERS OF APOWA ARE ENTITLED TO
THE FOLLOWING:
1.Membership card,
& sticker as available.
2.Eligibility for
membership in and benefits of any associate organisation of National and
International.
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