{"id":10599,"date":"2016-08-19T15:28:44","date_gmt":"2016-08-19T09:58:44","guid":{"rendered":"http:\/\/inclentrust.org\/new\/?page_id=10599"},"modified":"2024-08-27T17:04:06","modified_gmt":"2024-08-27T11:34:06","slug":"individual-membership-application-form","status":"publish","type":"page","link":"https:\/\/inclentrust.org\/inclen\/individual-membership-application-form\/","title":{"rendered":"Individual Membership Application Form"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column width=&#8221;1&#8243;][vc_button title=&#8221;Back &#8221; target=&#8221;_self&#8221; color=&#8221;btn-primary&#8221; icon=&#8221;none&#8221; size=&#8221;wpb_regularsize&#8221; href=&#8221;https:\/\/inclentrust.org\/inclen\/?page_id=5560&#8243;]<br \/>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f10576-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"10576\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/inclen\/wp-json\/wp\/v2\/pages\/10599#wpcf7-f10576-o1\" method=\"post\" class=\"wpcf7-form init cf7-style twenty-fifteen-pattern\" aria-label=\"Contact form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"10576\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f10576-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/div>\n<p><label>Name: <span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span><\/label><br \/>\n<label>Phone:<span class=\"wpcf7-form-control-wrap\" data-name=\"Phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"Phone\" \/><\/span><\/label><br \/>\n<label>Email:<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span><\/label><br \/>\nSex:<span class=\"wpcf7-form-control-wrap\" data-name=\"sex\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><span class=\"wpcf7-list-item-label\">Male<\/span><input type=\"radio\" name=\"sex\" value=\"Male\" checked=\"checked\" \/><\/span><span class=\"wpcf7-list-item last\"><span class=\"wpcf7-list-item-label\">Female<\/span><input type=\"radio\" name=\"sex\" value=\"Female\" \/><\/span><\/span><\/span><br \/>\n<label>Date of Birth: <span class=\"wpcf7-form-control-wrap\" data-name=\"dob\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" min=\"1972-01-01\" max=\"2022-12-31\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"dob\" \/><\/span><\/label><br \/>\n<label>Nationality: <span class=\"wpcf7-form-control-wrap\" data-name=\"nationality\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nationality\" \/><\/span><\/label><br \/>\nAcademic Qualification:\n<\/p>\n<table>\n\t<tr>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"qualification\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Degree (Highest)\" value=\"\" type=\"text\" name=\"qualification\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"special\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Specialization\" value=\"\" type=\"text\" name=\"special\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"com_year\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Completed Year\" value=\"\" type=\"text\" name=\"com_year\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<p>Employment Record\n<\/p>\n<table>\n\t<tr>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"NameofOrganisation\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Name of Organisation\" value=\"\" type=\"text\" name=\"NameofOrganisation\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td colspan=\"2\">\n\t\t\t<p>Type of Employment:<span class=\"wpcf7-form-control-wrap\" data-name=\"TypeofEmployment\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"TypeofEmployment\" value=\"Part Time\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Part Time<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"TypeofEmployment\" value=\"Full Time\" \/><span class=\"wpcf7-list-item-label\">Full Time<\/span><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"designation\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Designation\" value=\"\" type=\"text\" name=\"designation\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p>From:<span class=\"wpcf7-form-control-wrap\" data-name=\"from\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"from\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td>\n\t\t\t<p>To:<span class=\"wpcf7-form-control-wrap\" data-name=\"to\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"to\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td colspan=\"3\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DescriptionofWork\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Description of Work\" value=\"\" type=\"text\" name=\"DescriptionofWork\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<p>Statement of Purpose for Collaboration:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Statement\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"Statement\"><\/textarea><\/span><br \/>\nResume: <span class=\"wpcf7-form-control-wrap\" data-name=\"your-file\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file wpcf7-validates-as-required\" accept=\"audio\/*,video\/*,image\/*\" aria-required=\"true\" aria-invalid=\"false\" type=\"file\" name=\"your-file\" \/><\/span>\n<\/p>\n<p>\n\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<br \/>\n[\/vc_column][\/vc_row]<\/p>\n<div class=\"pvc_clear\"><\/div>\n<p id=\"pvc_stats_10599\" class=\"pvc_stats all  \" data-element-id=\"10599\" style=\"\"><i class=\"pvc-stats-icon small\" aria-hidden=\"true\"><svg aria-hidden=\"true\" focusable=\"false\" data-prefix=\"far\" data-icon=\"chart-bar\" role=\"img\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 512 512\" class=\"svg-inline--fa fa-chart-bar fa-w-16 fa-2x\"><path fill=\"currentColor\" d=\"M396.8 352h22.4c6.4 0 12.8-6.4 12.8-12.8V108.8c0-6.4-6.4-12.8-12.8-12.8h-22.4c-6.4 0-12.8 6.4-12.8 12.8v230.4c0 6.4 6.4 12.8 12.8 12.8zm-192 0h22.4c6.4 0 12.8-6.4 12.8-12.8V140.8c0-6.4-6.4-12.8-12.8-12.8h-22.4c-6.4 0-12.8 6.4-12.8 12.8v198.4c0 6.4 6.4 12.8 12.8 12.8zm96 0h22.4c6.4 0 12.8-6.4 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[\/vc_column][\/vc_row]<\/p>\n<div class=\"pvc_clear\"><\/div>\n<p id=\"pvc_stats_10599\" class=\"pvc_stats all  \" data-element-id=\"10599\" style=\"\"><i class=\"pvc-stats-icon small\" aria-hidden=\"true\"><svg aria-hidden=\"true\" focusable=\"false\" data-prefix=\"far\" data-icon=\"chart-bar\" role=\"img\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" viewBox=\"0 0 512 512\" class=\"svg-inline--fa fa-chart-bar fa-w-16 fa-2x\"><path fill=\"currentColor\" d=\"M396.8 352h22.4c6.4 0 12.8-6.4 12.8-12.8V108.8c0-6.4-6.4-12.8-12.8-12.8h-22.4c-6.4 0-12.8 6.4-12.8 12.8v230.4c0 6.4 6.4 12.8 12.8 12.8zm-192 0h22.4c6.4 0 12.8-6.4 12.8-12.8V140.8c0-6.4-6.4-12.8-12.8-12.8h-22.4c-6.4 0-12.8 6.4-12.8 12.8v198.4c0 6.4 6.4 12.8 12.8 12.8zm96 0h22.4c6.4 0 12.8-6.4 12.8-12.8V204.8c0-6.4-6.4-12.8-12.8-12.8h-22.4c-6.4 0-12.8 6.4-12.8 12.8v134.4c0 6.4 6.4 12.8 12.8 12.8zM496 400H48V80c0-8.84-7.16-16-16-16H16C7.16 64 0 71.16 0 80v336c0 17.67 14.33 32 32 32h464c8.84 0 16-7.16 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