Grameen Global Network Application Form
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1.0
Name :
2.0
Address:
Telephone:
Fax:
E-mail:
3.
Name of Organization (if any):
Name of Chief Executive:
Year of Establishment:
Nature of Services Provided :
Credit
Saving
Health
Education
Training
Others (please specify)
Is your organization replicating the Grameen Bank system:
Yes
No
If your answer to the above is yes, please provide date when replication started:
If you are not replicating Grameen, do you have any other association with Grameen Bank and
Grameen Trust. :
Attended Dialogue Program
Dates:
Planning to begin replication
Proposed date :
Attended Grameen Training
Dates:
Advocate/Supporter of Grameen
Contributor to People's Fund
Subscriber to Grameen Dialogue Newsletter
Other (Please specify):
5.
Affiliation, if any, with other national/regional/international network :