GREENTECH FOUNDATION 811,Vishwadeep Tower, Distt. Center, Janakpuri, New Delhi-110058, India Phones : 91-11-25593846, 25554739, 25540482, Fax : 91-11-41588564, 25612025 E-Mail : mail@greentech.org   Web site : www.greentech.org     MEMBERSHIP FORM   Company Name : ___________________________________________________________________________________ Address : _________________________________________________________________________________________ City : ______________ ZIP / PIN Code :_______________Country :_______________Website :___________________ Board of Directors (Attached list with addresses)__________________________________________________________ Products / Services :_________________________________________________________________________________ Established in Year :_________________Annual Turnover :_______________No. of Employees :___________________ Chairman cum Managing Director Name__________________________________________ Designation_____________________________________ Phone_____________________Fax_________________ Mobile______________Email_______________________ Additional contacts : Name__________________________________________ Designation_____________________________________ Phone_____________________Fax_________________ Mobile______________Email_______________________ Head of Environment Name__________________________________________ Designation_____________________________________ Phone_____________________Fax_________________ Mobile______________Email_______________________ Additional contacts : Name__________________________________________ Designation_____________________________________ Phone_____________________Fax_________________ Mobile______________Email_______________________ Head of Fire, Safety & Security Name__________________________________________ Designation_____________________________________ Phone_____________________Fax_________________ Mobile______________Email_______________________ Additional contacts : Name__________________________________________ Designation_____________________________________ Phone_____________________Fax_________________ Mobile______________Email_______________________ Head of Human Resources (HR) / Personnel Name__________________________________________ Designation_____________________________________ Phone_____________________Fax_________________ Mobile______________Email_______________________ Additional contacts : Name__________________________________________ Designation_____________________________________ Phone_____________________Fax_________________ Mobile______________Email_______________________ Location Information : If this membership application is for more than ONE location / Unit / Factory / Project and / or Offices other than the locatio mentioned above, please mention the number and name of the other locations :___________________________ __________________________________________________________________________________________________ Membership Fee : Period Indian Companies Overseas Companies One Year Rs.15,000/- US $ 500 Two Years Rs. 29,000/- US $ 950 Payment : The Membership Fee is payable by way of Demand Draft drawn in favour of 'Greentech Foundation' payable in New Delhi, (India). Date : ____________________ Seal of Company___________________    Signature with : ______________________                                                                                                             Name & Designation