Membership Form

Type of the membership :

☐ Full Member	☐ Associate Member

Name (with Abbreviation) of the Applicant organization:

3. Address with Telephone, e-mail, and web address:

4. Date of establishment:

5. Head of the Organization (Name, Designation, Contact Information:

6. Type of the Organization:

☒ L/NNGO ☒ INGO ☒ Network ☐ Other (Please Specify):

7. Organizational Objectives:

7. Organizational objectives

8. Disaster Risk Reduction/Response Activities & Geographical Areas Covered (summary or point form please):

9. Which agency the organization is registered with?

☐ Dept. of Social Science ☐ RJSC ☐ NGOAB ☐ Other, please specify:

10. Name of the other institutions, groups, or consortia to which your organization is a member:

Declaration:

☐ I confirm that all the information stated in this application is correct.

☐ I confirm that I will abide by the constitution of NIRAPAD as a member organization.

Signature with Date ……………….………………………………...........................

Name and Designation: …....………………………………………..........................

Supporting Documents

The following documents should be attached to the application of applying NGOs only:

Statutes, constitution, charter, or similar document;

Organizational strategic document;

Proof of non-governmental and non-profit legal status;

Annual report for the last 5 years;

Most Recent Financial statement including sources of income and current donors (audited if available);

Composition of executive body or equivalent (names and institutional affiliations);

All fields must be filled in before consideration by NIRAPAD

Please return the form to:

NIRAPAD Secretariat

Mail to: House # 560, Road # 08, Baitul Aman Housing Society, Adabor, Dhaka-1207

Web: http://www.nirapad.org.bd

You may also email this form to nirapad@nirapad.org.bd