Phone/fax: 02-9763 7804 http://www.nehuripd.org.au nehuripd@nehuripd.org.au

Membership Form

($50.00 fees apply for the membership)

To: The President,

Nepalese Forum for Human Rights and People’s Democracy (NEHURIPD) Inc, Australia

Application for membership

I hereby confirm my intention to be a member of Nepalese Forum for Human Rights and People’s Democracy Inc (NEHURIPD), Australia and will abide by its constitution. Any activity that negatively affects the integrity and reputation of this association will not be undertaken.

I confirm that I thoroughly read, understood and agreed to the mission and objectives of NEHURIPD, Australia.

Name: ……....................................... ……………………… Female: Male:

Citizen: ……………………………………….................

Add. In Nepal: …………………………………………………………..................................................

Add. In Australia: …………………………………………………………..... .......................................

Telephone No:

Home: …………………………… Work: …………………...........Mob: …………………

Email Add: ………………………………………………………………………………………………

Signature of Applicant: ……………………………

Date: -- ----/------/----------- (dd/mm/yyyy)