Membership Form
  1. We would like


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  2. NGO Type
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  3. Date registered in Cambodia

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  4. Name of recent donor/supporter
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  5. Total Annual Budget in the year applies for CCC membership
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  6.  
  1. About your NGO profile
  2. Name
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  3. Vision
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  4. Mission
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  5. Value
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  6. Goals
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  7. Organization's Description (no more than 300 words)
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  8. Main Sector



















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  9. 1. Office Address
  10. Address
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  11. PO Box
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  12. Email
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  13. H/P
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  14. Fax
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  15. Website
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  16. 2. Designated representative to attend CCC meetings
  17. Name
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  18. Email
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  19. Position
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  20. H/P
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  21. 3. Designated alternate to attend CCC meetings
  22. Name
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  23. Email
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  24. Position
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  25. H/P
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  26.  
  1. Number of Staff
  2. Total Staff
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  3. Total Local Staff
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  4. Total Expat Staff
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  5. Female
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  6. Project/Program (list down the title of your program or/and project)
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  7. Location Covered



























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  8. Total Direct
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  9. Female
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  10. Total Indirect
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  11. Female
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  12. Types of Beneficiaries:














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  13. Others
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  14. Note
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  15. Please type the text below and click submit button(*)
    Please type the text below and click submit button
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  16. Submit