Registration

Geo Amjad

Register with Us

If you are a disabled person and want to share your story, along with benefits from our side, register with us.

*Name:

*Fathers Name:

*Date of Birth:

Email:

*Mobile Number:

*CNIC No:

*Address:

*Education:

*Profession:

*Are You Working?:

Select.. Yes No

Nature of Work:

*City:

*Province:

*Cause of Disability:

*Approximate Date of Disability:

*Details of Disability:

*Your Life Story:

*Your Hobby:

*Treatment Taken:

*Do You Have Pressure Sore:

Select.. Yes No

*Present Situation:

*Nature of Disability:

*Your Experience:

*Are You Paralysed:

Select.. Yes No

Injury Level:

Area of Paralysis:

*Kind of Disability:

*Problem Which You Want to Share:

Maximum 500 words.