www.asiaspeaks.

org GPO: 8975 EPC: 394, Kathmandu, Nepal

This form is the property of Asia Speaks! and is not transferable to any third party. The holder who claims for it must legally be responsible for all the action, thereby produced, that may create debate regarding the copyright of this document.

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Asia Speaks! is a registered international trademark. Any duplicate or public use of its name without you proper involvement in the organization is severe violation of international trademark rule. All the maters stated here are the subjects of interpretation by Asia Speaks! only.

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National Member Application Form

(Attach 6$ with this form)

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I would like to apply for the paid volunteering on Asia Speaks! . I hereby agree to accept, be bound and abide by present and future rules and regulations of the organization. Name (In Capital Letters) Permanent Address Country Name: District/State/Province: Temporary Address Country Name: District/State/Province:

Tel:
(Country code) (Sub-code) (Extension)

Tel:
(Country code) (Sub-code) (Extension)

Cell: E-Mail: @ Postal Address:

IF ANY SPECIFICATION, MENTION BELOW IN BLOCK LETTERS:

Cell: E-Mail: @ Postal Address:

Health Situation

Blood Group

Problem Statement

DOB: Citizenship: Disclaimer:

GMT

(If any problem, write in block letter; if not, leave it blank)

Passport Details: Passport No. : Education: Lic. Inc. No. : Other:

Photo-3 (Put your signature on photo coverings.)

Medicine Referred:
(for long term disease only)

IF ANY SPECIFICATION, STATE: (if not, leave it blank)

JOB SPECIALIZATION (FOR OFFICIAL USE ONLY)

.voice up your voice

www.asiaspeaks.org GPO: 8975 EPC: 394, Kathmandu, Nepal

Email Original Copy

.voice up your voice