* = Required Information

Volunteer Collaborator WAAD Member
City * State County * Zip Code *
Home Phone * Cell Phone * Email *
Gender MaleFemale
Submit Full Proposal Now? YesNo

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: