1.	Full Name (In Block Letters):
2.	Father Name:
3.	Mother Name:
4.	D.O.B :		Place Of Birth :
5.	Marital Status :	Married	Unmarried
6.	If Married Spouse Name :
7.	Gender :	Male	Female	Others
8.	Nationality :		Home State :
9.	Address :
10.	Contact No. :		E-Mail Address :
11.	Profession :
12.	Motivation Behind Joining :

Are you involved or attached in any other Social/Political Organisation? If Yes, Please mention Name of organisation & your designation in the organisation:

Identity Proof Attached with I.D. No :

DECLARATION: I hereby declare that I have carefully read the requisite norms of good conduct & the tenets of “Prayaas Foundation as per the objectives laid down in resolution close.”I will fully adhere to the said norms of good conduct & tenets Drug Awareness/De-addiction programme. In the event of violation of rules by me under any circumstances, “Prayaas Foundation” is free to take any disciplinary action against me without any show-cause notice, for which I shall be fully responsible. Please register me as a volunteer of “Prayaas Foundation” in accordance with the rules of “Prayaas Foundation.”

Date :		Signature of the Applicant :
Reference By :		Contact No :		Signature :