Application for Associate Membership of Workability Asia (Individual / Organization) 1. Details of applicant: Name Address Country Bangladesh Cambodia Hong kong India Japan Macau Malaysia Nepal Philippines Taiwan Thailand Vietnam Email Website 2. Signatory: Name Date 3. Membership fee and the Solidarity Fund: Annual membership fees as per the table below. Other than the membership fees the Solidarity Fund is to make it more viable and sustainable the activities of Workability Asia. The Solidarity Fund is your voluntary contribution. One unit of the Fund is US$100.00. * Associate Member -Individual - $100. * Associate Member -Organization - $200. Solidarity Fund Unit(s) 4. Our Bank Account: Bank Name: BANGKOK BANK PUBLIC LTD., Banglamung Branch Name: The Redemptorist Foundation for People with Disabilities for WAsia Account Number: 342-4-75838-5 Swift Code: BKKBTHBK (www.bangkokbank.com) Bank Address: Pattaya City, Chonburi, Thailand Tel: (66 2) 645-5555 5. Please email your latest annual report and/or brochure of your organization with your application to: Ms. Nayantara Janardhan Email: nayantara@enableindia.org Website: www.workabilityasia.org I hereby confirm all the information is correct and that I have read and accepted the Privacy policy and the Terms of service of Workability Asia. Submit
