* = Required Information
Volunteer
Collaborator
WAAD Member
Name
*
Employer/Business
*
Current Address
*
Please select state.
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
City
*
State
County
*
Zip Code
*
Home Phone
*
Cell Phone
*
Email
*
Gender
Male
Female
Profession/Area of Specialization
Proposal Topic
Target Area/Country
Target Beneficiary
Sponsorship Drive
Plans for Funding
Contacts Already Made
Timeline
How Did You Hear About WAAD
Submit Full Proposal Now?
Yes
No
Attach Proposal
DECLARATION
I
*
hereby declare that my submission of initiative proposal is to support WAAD vision, mission, and rules set for the association. I agree to collaborate with WAAD for successful execution of the initiative project. At any time, WAAD or I can terminate this agreement. I further declare that all the information�s mentioned in this form are true and correct to the best of my knowledge and believe. I have not concealed any information, should it be so at any point of time, my collaboration with WAAD is liable to be terminated. I also declare to abide by all the rules and regulations laid down by the Governing Council of WAAD.
Applicant Signature by Name:
Date: