MEN AGAINST VIOLENCE & ABUSE (MAVA)

12 –A, Parishram Building,Bhandar Lane, Lady Jamshedji Road, Mahim, – 400 016.

 Membership Form (Please use capital letters)
Name in full: _______________________________________________________
Residential Address: _______________________________________________________
  _______________________________________________________
  _______________________________________________________
Phone Nos: Res: ________________________
Mobile No: ________________________
Office No: ________________________
Date of Birth: ________________________
Marital Status: ________________________
Educational Qualifications: _______________________________________________________
Current Profession with Designation: _______________________________________________________
Languages Known: _______________________________________________________
Special Skills: _______________________________________________________
  _______________________________________________________
Are you a member of any voluntary organization? If so, please give details.
  _______________________________________________________
  _______________________________________________________
Are you associated with any political group? If yes, please give details.
  _______________________________________________________
  _______________________________________________________
   
Would you like to volunteer for any activities / programs of MAVA? If yes, please tick the ones given below, for which you can spare time & skills:
______
 Provide counselling & guidance to men and women contacting MAVA
______
 Raising awareness on gender issues
______
 Office-Administration
______
 Raising funds for the organization
______
 Soliciting new members
______
 Organising events
______
 Liasoning and networking with women’s groups & other organizations
______
 Any other activities.
Specify:
 __________________________________________________________________________
   
Membership Subscription Rates:
Ordinary Member : Rs.200 per annum
Life Member : Rs.1000 lumpsum
Patron : Rs.5000 lumpsum
 
Please send your subscription fee by cheque / demand draft / cash payable to Men Against Violence & Abuse at the address given above.
 
MAVA reserves the right to accept / terminate / refuse membership, without an explanation being given to the person concerned.