Disability Alliance of Voluntary Organisations

Name ^*

Gender ^*

Male Female

Age

Postal Address

Phone ^*

E-mail ^*

Educational Qualifications (Please tick)

Pre-degree Under-graduate Post-graduate Doctorate Any other (please specify)

Current Occupation

Specialisation ^*

Will you be available for services to other organisations when needed

Yes No

In what areas would you be willing to offer consultancy services, when required (please list 5 areas)

How much time may be available in a year to offer services?

Less than 10 days 11-20 days 21-30 days 31-60 days 61-90 days More than 90 days

Any other information

Consultation