CAPP - Campaign Against Plastic Pollution

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Application form for life/annual membership

Full Name

Father's Name

Image

Gender

Marital Status

Name of Spouse

DOB

Present Address with pincode

Permanent Address with pincode

Contact Details

Telephone (with STD code) Office

Telephone (with STD code) Residence

Mobile

WhatsApp Number

Fax

Email Address

Facebook ID(if any)

Twitter ID (if any)

Educational Qualification

Present Occupation / Designation

Self attested passport/voter id/driving licence

Please indicate in not more than 150 words how you wish to contribute in the activities of the Foundation for Campaign Against Plastic Pollution:

Do you know any existing member of the Foundation

please indicate her/his name

Any other relevant information about you or your achievements that you would like to share:

Type of Membership sought

Reference Number of Deposit of Membership Fee

Date

Place

Name

Membership-Plan

I am depositing Rs.

Foundation’s account no:

IFSC Code:

Date:

Canara Bank, Sector P-2 Branch, Greater NOIDA by NEFT/cheque/DD No.:

NOTE:

*Fee for lifetime membership is Rs. 5000/- one time and fee for annual membership is Rs.500/-

** After clicking “Submit” button, please download the form, print it, sign it and post it along with cheque/bank draft (drawn in favour of “Foundation for Campaign Against Plastic Pollution”) of membership Fee to:
Foundation for Campaign Against Plastic Pollution
66, Greenwoods Society Phase-2
Sector Omega-1, Greater Noida-201310.

*** In case, you need any clarification, please call 9958806956

Registered Office:

Foundation for
Campaign Against Plastic Pollution
66, Greenwoods Govt Officers Welfare Society
Phase 2 Sector Omega – 1
GREATER NOIDA
PIN-201310
District-Gautam Buddha Nagar
Uttar Pradesh, INDIA

Directors:

1. Anoop Kumar Srivastava
2. Akash Shinghal

Contacts:

Call Us: +91-9958806956
Email Us: foundationforcapp@gmail.com

Members:

1. Anoop Kumar Srivastava
2. Uma Srivastava
3. Pushp Dant
4. Seema Bhargava
5. Thangi Mannen