Membership Form
EHRDC membership form
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Full Name *
Gender *
Age *
Phone Number *
Email Address *
Current Residence and Address- City *
Educational Background *
Employment Status *
Emergency Contact Name *
Phone Number *
Your or your organizations  affiliation with human rights  ( activities you are engaged in as a human rights defender) *
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. *
Full name *
Date *
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