Registration form

I/We,_______________________________________________ (name) would like to participate actively in the Asia Pacific Humanist Forum 2007 to be held from 16th to 18th March 2007 at Mumbai, India.

I/We would like to participate in the organisation body of the Forum.

Our profile: voluntary organisation or individual or electronic or print mass-media or journalist:

o Year of establishment: _______________________________________________________

o Main subjects/fields of interest: ________________________________________________

o Geographical areas of activities: Urban / Rural / Both

Cities/villages: ______________________________________________________________

District: _________________ State: ________________ Country: _____________________

Contact details:
Name of the contact person:__________________________________________________

Male/Female Occupation: _______________ Birth date: ________________________

Name of the organisation: ______________________________________________________

Address: _____________________________________________________________________
_____________________________________________________________________________
City: ____________ State: __________ Pin code: __________ Country: ________________

Tel: STD code: __________ (O)______________(Mobile)______________ Fax: __________

Email: _________________________________________________________________
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