Blind Graduate's Forum of India Membership Form

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To
The Hon-Secretary
BLIND GRADUATES FORUM OF INDIA

Dear Sir/Madam
I am in agreement with the aims and objectives of BLIND GRADUATES’ FORUM OF
INDIA and agree to abide by its rules and regulations made from time to time. My personal
details are as following –

Name *

Current Address *

Permanent Address(Write "Same as current address" if same as current address.) *

Mobile Number *

Landline Number

Email ID *

Date of Birth *

YYYY

Gender *

Female

Male

Marital Status *

Single

Married

Divorced

Widowed

Do not wish to disclose

Nature of Blindness *

Totally Blind

Partially blind

Night blindness

Color blind

Sighted

Cause of blindness

Age at which blindness occurred *

Any other illness or disability *

Educational Qualification (mention if any specialization done) *

Braille knowledge *

Can read and write braille

can only read braille

Don't know Braille

Languages Known *

Any special skills, aptitude, etc.

Extra-curricular Activities

Occupation Details *

self-employed

professional

working in public sector

working in private sector

unemployed

Enroll me as *

Life Member (Rs. 105)

ordinary member (Rs. 15) for yearly membership ending 31st December

associate life member (Rs. 105)

associate member (Rs 15) for yearly membership ending 31st December

I am in agreement with the aims and objectives of BLIND GRADUATES' FORUM OF INDIA and agree to abide by its rules and regulations made from time to time.

Required

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