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Membership Form
EHRDC membership form
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* Indicates required question
Full Name
*
Your answer
Gender
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Female
Male
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Age
*
>18
18-30
30-45
<45
Phone Number
*
Your answer
Email Address
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Your answer
Current Residence and Address- City
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Your answer
Educational Background
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Your answer
Employment Status
*
Employed
Unemployed
Self-employed
Student
Required
Emergency Contact Name
*
Your answer
Phone Number
*
Your answer
Your or your organizations affiliation with human rights ( activities you are engaged in as a human rights defender)
*
Your answer
I have signed on this member ship form with my full consent and knowledge after I read\ it has been read for me and I hereby fully agreed with the whole concept of the organizations visions and mission that I confirm with my signature below.
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Full name
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Your answer
Date
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