Ms. Wheelchair INDIA You Could Be the 1st
Ms. Wheelchair India !!
ENTRY FORM
Kindly attach 2 colour photographs, 1 close-up & 1 full length, and copy of Disability Certificate
1. 2. 3. 4. 5.
NAME - _____________________________________________ DATE OF BIRTH - ___________ NATIONALITY - _____________ MARITAL STATUS - _______________ ADDRESS - _________________________________________ ____________________________________________________ ____________________________________________________ 6. EDUCATIONAL QUALIFICATIONS - ________________ 7. OCCUPATION - ___________________ 8. HEIGHT - _________ (Feet) 9. WEIGHT - _________ (Kgs) 10. COLOUR OF HAIR - _________ 11. COLOUR OF EYES - _________ 12. COLOUR OF SKIN - _________ 13. HOBBIES - _________________________________________ ____________________________________________________ ____________________________________________________ ____________________________________________________ 14. CONTACT NUMBERS - _____________________________ 15. EMAIL ID - _________________________________________ ______________________ (Signature of Contestant)
__________ Date
Mail your entries before 30th September 2013 toMR. SOUNAK BANERJEE Hon. Chief Advisor 504, Sonam Shraddha, Golden Nest -1 Mira Bhayandar Road, Bhayandar (E) Mumbai - 401105 www.mswheelchairindia.org