Register

Registration form to participate in the I-CCM Civil Society Election Process

Mandatory Fields *

Name of the organization *

Address *

Pincode *

Contact Details

Telephone (Landline) *

STD		Landline
	-

Email id *

Organization Head

Name *

First Name		Surname

Position held in organisation *

Is your organization registered as a Society/Trust *

Year of registration * (YYYY)

Registration number *

Areas of Organizational Interest *

HIV TB Malaria Gender Sexual minorities Child development and Rights Health System Strengthening

Number of states that your organization works in *

Names of the States *
(Multiple selection using CTRL +Click)

Priority area for your organization *
(As you will be voting under the sub-sector you have selected)

Are you implementing any projects in these areas of interest *

Yes No

Expenditure made on the project in the last year *

Lacs

Do you want to stand for election to be representing any of the sub-sectors on the India-CCM *

Have you been previously associated with the India-CCM or GFATM grants in any capacity? If yes, Please indicate how *

Verification Code *

Enter the code above here :

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