E-Merge Registration FormMEMBERSHIP APPLICATION FORM For 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 42061929email ID: emerg@emergndia.org website : www.emergindia.orgPlease enable JavaScript in your browser to complete this form.Section A: Personal Details - Name *Address Communication Should Be Sent To *Phone Number *Email *Enter PAN Number * List of Organization that you are member of Awards / Recognitions if anyCategory applying under (please check the relevant box) *IndividualPartnershipInstitutionProprietorshipCorporateWorking professionalPublic Ltd. CoAssociationOthers (Pl specify)Private Limited CoWomen’s GroupSection B1: Business Details(Individuals and Registered Companies) Business Name: *Business Address *Business Phone Number *Business Email *Nature of the Business, Products and Services ProvidedYour Designation and ResponsibilitiesYear Of Business Established *Business Website *Referred by *How did you come to know about eMERG? *SelectLinked inInstagramChoice 3Section B2: Business Details (Registered Companies Only)-Business PAN No / GST No Registered Companies OnlyCo / Udyog Aadhar (UAM) Registration No. and DateTotal Number of EmployeesHow many employees are *FirstLastInvestment in Indian Rupees (INR)Turnover in INR: Last 3 Financial YearsFirstMiddleLastEmailRegister
