Name*

Age*

Occupation*
—Please choose an option—StudentWorking professionalOthers (Specify)

Please specify your Occupation

Designation (if you are a working professional)

College / Organization Name*

Place*

District*

Email ID*

Phone number 1*

whatsapp enabled?

Phone number 2

whatsapp enabled?

Do you have any specific skills (Ex: Electrical wiring, plumbing, Carpentry, Designing electrical devices etc.)

How can you contribute?*
Visiting the place for survey / Distribution of relief material etcCollection of materialCoordination of volunteersManaging social media campaignsTechnical activities developing relief material like LED torch lightDocumentationOthers (Specify)

Please specify your Occupation