GRAM SWARAJ ABHIYAN
Institutional Membership Form
Registration No. ….,…../………./…………../………../………….
Institutional Information
Name of the organization :
Whether registered : Yes/ No
If yes, (society/trade union/
trust/cooperative etc.) :
If no, kind of institution : People’s organization/ group/ students union/ labour union/ federation/
others
Correspondence address :
Telephone : Fax: Email ID :
Operational area (village, Panchayat, block, districts)
Kind of interventions
Your contribution to Gram Swaraj Abhiyan
Full time Selected activities As per convenience
In what way you can contribute to Abhiyan
Your expectation from Abhiyan
Our values
◙ Peace & Harmony ◙ Gender Equity
◙ Secularism ◙ Equity & Social Justice
◙ Participatory & Collective democracy
As a member I/ we have great faith in the values listed above and would strive for the promotion of these
values the for creation of still a better world.
Date Signature
……………………………………………………………………………………………………………
RECEIPT
Registration No. ….,…../………./…………../………../…………..
…………………………………………………
is our valued partner of Gram Swaraj Abhiyan, an abhiyan for the creation of a better world.
Received a sum of Rs. ………………… as an institutional fees for Gram
Swaraj Abhiyan. (Receipt No. ………………..dated …………………
Date Signature
GRAM SWARAJ ABHIYAN
Individual Membership Form
Registration No. ….,…../………./…………../………../………….
Individual Information
Name of the person :
Profession :
Correspondence address :
Telephone : Email ID :
Your present social responsibilities
Your contribution to Gram Swaraj Abhiyan
Full time Selected activities As per convenience
In what way you can contribute to Abhiyan
Your expectation from Abhiyan
Our values
◙ Peace & Harmony ◙ Gender Equity
◙ Secularism ◙ Equity & Social Justice
◙ Participatory & Collective democracy
As a member I have great faith in the values listed above and would strive for the promotion of these values
the for creation of still a better world.
Date Signature
……………………………………………………………………………………………………………
RECEIPT
Registration No. ….,…../………./…………../………../………….
…………………………………………………
is our valued partner of Gram Swaraj Abhiyan, an abhiyan for the creation of a better world.
Received a sum of Rs. ………………… as an individual fees for Gram Swaraj
Abhiyan. (Receipt No. ……………….. dated …………………
Date Signature
