National Membership Form
Name of NGO ______________________________________________________________
Contact Person ______________________________________________________________
Email of Contact Person ______________________________________________________________




Telephone No. _______________________________________
Fax No. _______________________________________
Website _______________________________________
Details of DD ( DD to be payable to Pvt Ltd. Mumbai based NGOs can pay by cheque).

Rs.26,966.40/- (Basic fee Rs.24,000/- +12.36% Service Tax)
(Rupees Twenty Six Thousand Nine Hundred Sixty Six & Forty Paise Only)

Mode of Payment

Cash Credit in ICICI Bank
Cheque Credit in ICICI Bank
DD by Courier
by Courier

DD / Cheque No. ___________________________________________
DD / Cheque Dated ___________________________________________
Bank ___________________________________________



Send the form and fees to
Pragati Nandgaonkar Pvt Ltd
6 Devendra Apartments
Next to Sahyog Mandir
Ghantali, Naupada
Thane 400602
Email :