NEW PARENT REGISTRATION                                   Member Sign In

Details of Child:                                                                                                    

Child Name	*	Age	*
Date of Birth	*	Gender	- Select - Male Female *
Types of Disability	- Select - Mental Retardation Cerebral Palsey Austism Multiple Disorder Others *
Details of Father:                                                              Details of Mother:
Name	*	Name	*
Occupation	*	Occupation	*
Address	*	Address	*
Telephone No. / Mobile Number	STD / ISD Code - Phone No.	Telephone No. / Mobile Number	STD / ISD Code - Phone No.
E-Mail ID	*
Details of Siblings:	Name	Age	Gender
1.			- Select - Male Female
2.			- Select - Male Female
3.			- Select - Male Female
We hereby apply for the membership of MAITHREE and if accepted for membership agree to governed by the rules and regulations of the association
We also agree to pay the subscription* Registration Fee - Rs. 30/-  Annual - Rs. 120/- Life Membership - Rs.1000/- Total Amount:		Special request, needs, expectations and suggestions.

The applicant should be introduced by a member and membership is subject to approval by the executive committee.

Introducer

                                    I accept the rules and regulations of Maithree