Volunteer Registration Form printable pdf download

Volunteer Registration Form

:: HP SDMA Volunteer Registration Form ::

NAME OF THE APPLICANT

Affix

Your

GENDER

DATE OF BIRTH

BLOOD GROUP

Passport

(TICK MARK IN THE BOX)

(ACCORDING TO 10

MARKSHEET)

(ENTER ONLY IF YOU KNOW)

Size

Example: A B +

Male

Female

Photograph

Here

FATHER’S NAME

ADDRESS FOR CORRESPONDENCE

PIN Code:

PHONE NUMBERS

LANDLINE

STD Code:

Phone No.:

MOBILE

E-MAIL ADDRESS

(IF ANY)

EDUCATIONAL QUALIFICATION

(PLEASE WRITE THE MOST RECENT QUALIFICATION IN FIELD NO. 1)

TITLE OF THE DEGREE/ COURSE / CLASS

STREAM

SCHOOL/ COLLEGE/ UNIVERSITY

YEAR

PRIOR EXPERIENCE/EXPERTISE IN DISASTER MANAGEMENT RELATED ACTIVITY

(IF ANY)

DISASTER-SPECIFIC AREA YOU WANT TO GET TRAINED IN

(TICK MARK THE SUITABLE ONE)

Medical First Aid:

Search & Rescue:

Relief :

Other:

EMERGENCY CONTACT PERSON

(NOTE- THIS MUST BE A FAMILY MEMBER, GUARDIAN OR A CLOSE RELATIVE)

NAME

ADDRESS

Mobile No.:

PIN Code:

DECLARATION

(TO BE FILLED IN BY THE APPLICANT ONLY)

I, _________________________________, hereby declare that I am keen to become a volunteer for the HPSDMA and

want to render selfless services for effective disaster management. By submitting this form, I declare that my age is 18+

years and that all the information provided by me in this form is true, correct and complete.

Date_________________

Place___________________

Signature of the Applicant___________________

Kindly send the duly filled-in Form at the following address:

NOTE: Please write ‘HPSDMA Volunteer

Himachal Pradesh State Disaster Management Authority (HP SDMA)

Registration Form’ on the top of the envelope

Disaster Management Cell, Deptt. of Revenue, H.P. Secretariat, Shimla- 02

or in the subject of the e-mail.

Or e-mail the scanned copy of the duly filled-in form at: sdma-hp@nic.in

Volunteer Registration Form

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