MEMBERSHIP APPLICATION FORMFor Women in Technology, Business, Profession &Service To The Hon. Secretary, ENGINEERING MANUFACTURER ENTREPRENEURS RESOURCE GROUP #51, 15th cross, AECS layout, Sanjaynagar. Bangalore - 560094 Telefax: 080 42061929 email ID: emerg@emergndia.org website : www.emergindia.org Please enable JavaScript in your browser to complete this form.Section A:Category applying under (please check the relevant box): *IndividualPartnershipInstitutionProprietorshipCorporateWorking professionalPublic Ltd. CoAssociationOthers (Pl specify)Private Limited CoWomen’s GroupSection B1: Organization Details: a. Organization Name: *b. Organization Address: *c. Organization Telephone *Organization Email *e.Nature of the Organization, Products and Services Provided: *f. Contact Person Name, Tel, Email, Designation and Responsibilities:g. Year Organization Established: *h. Org Website: *i.Referred Byj. How did you come to know about eMERG? *Section B2: Organization Details(PLEASE FILL IN ALL APPLICABLE FIELDS) a. Business PAN No / GST No: *b. Co / Udyog Aadhar (UAM) Registration No. and Date: *c. Total Number of Members: *d. How many Members are: *Women: *Women in a technical role: *e: Other Memberships currently held: *Section C: Membership Details a.Membership requested in the names of following 5 Members: NamePhone NumberDesignation(R)Name (2)Phone Number Designation(R)Name (3)Phone NumberDesignation(R)Name (4)Phone NumberDesignation(R)Name (5)Phone Number Designation (R) Submit
