JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Industrial Waste Management Association
Member details
Sign in to Google
to save your progress.
Learn more
* Required
Email
*
Your email
Name of the Industry
*
Your answer
Membership Number
Your answer
Communication Address
*
Your answer
Address of Factory located (as per consent order)
*
Your answer
District
*
Choose
Ariyalur
Chennai
Coimbatore
Cuddalore
Dharmapuri
Dindigul
Erode
Kanchipuram
Kanniyakumari
Karur
Krishnagiri
Madurai
Nagapattinam
Namakkal
Nilgiris
Perambalur
Pudukkottai
Ramanathapuram
Salem
Sivaganga
Thanjavur
Theni
Thoothukudi
Tiruchirappalli
Tirunelveli
Tiruppur
Tiruvallur
Tiruvannamalai
Tiruvarur
Vellore
Viluppuram
Virudhunagar
TNPCB Office - Jurisdiction
*
Choose
Ambattur
Ariyalur
Chennai
Cuddalore
Coimbatore (South)
Coimbatore (North)
Dindigul
Dharmapuri
Erode
Gummidipoondi
Hosur
Karur
Kumarapalayam
Maraimalai Nagar
Madurai
Namakkal
Nagapattinam
Nagercoil
Ooty
Perundurai
Pudukkotai
Ramanathapuram
Sriperumpudur
Salem
Sivagangai
Tiruvallur
Thiruvannamalai
Tiruppur (North)
Tiruppur (South)
Thanjavur
Trichy
Theni
Tirunelveli
Thoothukudi
Vaniyambadi
Vellore
Villupuram
Virudhunagar
Contact Number 1
*
Your answer
Contact Number 2
*
Your answer
Landline Number
Your answer
TNPCB Category
*
Choose
Red
Orange
Green
White
Industry segment
Choose
Automobile & ancillary
Textile & ancillary
Foundry
Forging
Leather
Chemical
Petroleum and ancillary
Food & organic
Waste Management & recycling
Others (please specify)
Industry segment - if others
Your answer
IWMA membership type
Individual
Associate
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of IWMA.
Report Abuse
Forms
