membershipform

MEDIA@NEEF
Post Box No. - 9020, Mumbai - 400 063.

 

 

 

 APPLICATION FOR__________________________________________________________

  ( Type the name of assignment desired)

 

 Name _____________________________________________
                                                                                                                     
 Sex _______________________________________________                                
                                                                                                                     
 Date of Birth________________________________________

 Marital Status_______________________________________

 Nationality _________________________________________

 

Paste

Photo

Here

Address for Communication _________________________________________________________________
(Please inform if changes)
_________________________________________________________________________________________

_____________________________________________Pin Code____________________________________

Tel:____________________Fax:___________________Email:_____________________________________
 

Qualifications_____________________________________________________________________________
  (Enclose attested copies of marksheets, testimonials and other details)

Work Experience__________________________________________________________________________

Present Profession_________________________________________________________________________

Physical Appearance:

Height ___________Weight ___________Colour of:  Skin ________Eyes ________Hair ____________

Figure ___________

Languages Known____________________________________________________________________

Extra Curricular Activities______________________________________________________________

Family Details:

Father's Name________________________Age______________Profession_____________________

Mother's Name_______________________Age______________Profession_____________________

No. of Brothers________________________Sisters________________________________________

References (Name, Address and Tel/Fax/Email)___________________________________________

Registration/Application fee paid(Rs.)___________________________________________________  

Declaration :- This is to certify that above statements and information given by me is true and I will be solely
responsible for any fact suppressed/concealed.

Place:
Date:

Signature of the Candidate

Note: a) Please use separate sheet if necessary.
           b) In addition to above photo, more photographs, portfolio, audio-video cassettes may be required.
           c) A  Registration Fee of  200/- is to be paid with application.
           d) All DD/Cheques/IPO /MO must be payable to National Ecology and Environment Foundation, Mumbai.