APPLICATION FORM FOR ASSOCIATE MEMBER (NGOs)

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Category: (B) Institutional Members

Qualifier: NON GOVERNMENT ORGANIZATIONS

ANNUAL SUBSCRIPTION - Rs. 2,500 per year
DETAILS:
Name of Organization  
Director/Head of Organization  
Address  
   
   
Telephone   Fax  
Email   Institution website www.
 
Year of establishment of the Organization    
Human Resource:
Total No. of Employees        
Total No. of Scientists        
No. of Ph.D.   No. of M.Sc.   No. of B.Sc.  
Others    
 
Principal officers (names and titles):
   
   
   
   
Contact Person  

Brief description of organization's activities:
   
   
   
   
 
What segment best qualifies your involvement/interest? (Select a maximum of 3 areas and rank them, in descending order, from 1 to 3 with 1 being the area of most interest.)
Agri-Biotech Environmental protection
Animal Welfare Education
Appropriate/alternate technologies Food
Biodiversity Human Health
Bioethics Information centre/database
Bioremediation Publications
Career information/counselling Regulatory
Other (Please Specify):    

What is your objective in joining ABLE? (Tick all that apply)
Mentoring  
Career mentoring Start-up mentoring
Networking
Social Issues
Education		  
Other (Please specify)  
 
Would you like to volunteer your talents for ABLE?Yes     No
If yes, please indicate your interest in volunteering for the following program(s)
ABLE events
Website Maintenance
Mentoring
If yes, provide your contact information:
Name  
Address  
   
E-Mail  
Phone  
 
Web Linkage to ABLE Resource Centre:
Would you like your institution's website to have linkage from ABLE website?Yes   No
If 'Yes' please confirm the linkage and the referral e-mail.
Website Linkage www.
e-mail  
 

Signature		     Date  
 
Please return completed form to the address below along with theannual subscription fees of Rs. 2500 paid by cheque/DD made in favour of ASSOCIATION OF BIOTECHNOLOGY LED ENTERPRISES.

ABLE Secretariat
No. 13, 2nd Floor, 4th C Block, 10th Main Road, Koramangala, Bangalore - 560034, India.
Telephone:
E-mail:
Website:

ableindia.org