Participation form ICCED

Dear loving being

Please give a few minutes to complete this form & return to ICCED

1. Name, nickname or any other “label”, ID you wish to be called by.
2. Date of birth: day, month, year
3. Education ( formal or informal)
4. Past professional experiences
5. Present occupation
6. Future ideas and plans

7. In which one of the following capacities you wish to be with us:

A. Founder-sponsor (show a generous action.)
B. Top management executive (send your resume.)
C. Guest of Honor (send your qualifications, may be only a personal photo.)
D. Colleague (send your qualifications + personal resume.)
E. ICCED branch-office in your community (send the history of your community work.)
F. Free-User (send your emotional problems.)
G. Regular member (send 9:00 USD for membership fee, to…… wait…………
8. E-mail address + any other contact number (tel. Fax, mobile,…)

9. (Optional ) name any other loved one you know, whom you feel ICCED service may be helpful.

(write their contact addresses to me.)

thank you
mohsenlove@gmail.com