My Clean India Association

2008

Membership Application Please return to

Mr Taru P Bhandari

1/143, Vivek Khand, Gomtinagar

Lucknow UP 226010

My Clean India

Membership Application Form

I herewith make application to become a member of the My Clean India Association (MCI).

Please tick all boxes as indicating compliance. You may fill in this form on computer and then print out..

I have read and accepted the Memorandum of the My Clean India Association

I have read the "Introducing My Clean India" document

My personal vision is (in less than 20 words (with examples on the About page of the MCI webpage). Say

something you feel passionate about and would like to share)

I may be available with the following services (eg. enrolling community members, providing support,

provision of services [identify] etc) to help MCI.

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My brief biography/CV (less than 30 words)

My photograph is enclosed (head & shoulders portrait; digital preferred that you may email to MCI).

I have read and promise to uphold the MCI Oath (next)

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My Clean India

Membership Application Form

Page 3 of 4

I will be involved with MCI activities in a responsible manner with regard to the safety of others, and in

manner consistent with local laws and practices including the disposal of litter and waste.

I will stay informed and respond to developments including those received by email and on the MCI

website consistent with local laws and practices.

I will conduct any activities of MCI in a spirit of a community service and acknowledge MCI.

If I provide photographs and articles to MCI, I agree to allow their use for promotional purposes (and, if

relevant, respect the privacy of others by having their permission).

I will promote the logos of sponsors and partners where required by MCI.

I will only make representations on behalf of MCI with the written permission from an authorised officer of

My Clean India Association.

I will respect these requirements or cease acting as a member of the My Clean India association.

The person signing this agreement has the organisational authority.

My membership donation is enclosed1.

Signed

Name

Date

Contact details

Name

Address

Mailing address (if different to your address)

Landline telephone

Mobile phone

Email address

Fax number

1 A donation of any value is welcomed but not obligatory.

Congratulations!

Consider yourself a member of MCI. Now what??

Well, a really easy, exciting and important opportunity is to promote a Clean Up Day in your city, town or

village for the third weekend of September each year. More information is provided on the Introducing MCI

document but basically it is about making contact with the people in your community and inspiring them for

this special occasion to recognise people that are making a difference to the environment. Of course take the

opportunity for the cleaning up of your community and promoting other events such as poster and essay

competitions, cleanest streets, and surveys results. The Clean Up day can begin the transformation towards

cleanliness.

Another really effective opportunity is the My Clean India ribbon. One gets requests to wear them just from

wearing one yourself.

There are actually many opportunities as you can read on the Introducing MCI paper

and this is yours now to make a difference to the environment by working with

people. It is easy, satisfying and empowering.

MCI believes that in accepting you as a member that you will now commit to some

of the actions available to you. The bullet points on the Introducing MCI paper can

be used as checkboxes with easy steps that represent an opportunity to

inspire other people who will in turn, inspire others towards a vision of My Clean

India. What an exciting future we are creating! We are delighted you are working

with us.