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Su Iccha Membership Form
By filling this form you agree to sign the Member Register of Su Iccha Foundation.
Email *
Name
Gender
Please mention your Interests, Hobbies and Skills
Date of Birth
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/
DD
/
YYYY
Phone number
Residential Address
Type of Id proof (Please mail yourid proof along with a photograph at suicchafoundation@gmail.com)
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Joining as *
Required
Have you been victim of sexual abuse? *
I affirm that I have been not been involved/committed in any act of sexual harassment or mental  harassment and I affirm that If I have been involved in the past, I have remorse, and I am a changed person now. *
I agree to pay 100 Rs as Membership Fee. (Rs 10 in case of Honorary Member) *
OATH: I take an oath that I will not be involved in any acts related to sexual offences in future and I shall speak up and do my best to prevent all types of sexual harassment in my everyday space. (Answer with I do) *
A copy of your responses will be emailed to the address you provided.
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