<p> INDIAN ASSOCIATION OF MUSCULAR DYSTROPHY</p><p>1. Name ……………………………………Date ……………………... 2. S/O, D/O, W/O. …………………… Date of Birth ………………… 3. Registration No.(Office Use Only).. ………………………………… 4. Address:- ……………………………………………………………. …………………………………………………………… ………………………..Pin Code ………………………. Colour 5. Gender (Male/Female) ……………………………………………….. Pasport 6. Telephone No. 1) …………………2)………………3)……… ……... Size Photo 7. Type Of Muscular Dystrophy :- A) EXION ………………………………………………...... B) RESULT ……………………………………………………..</p><p>6. Marital Status :- Un Married / Married / Widower / Widow. 7. Email Id ………………………………………………………………. 8. Education Uneducated / Primary / Middle / Sec. Secondary / Graduate/</p><p>Other ………………………………………………………………….. 9. Occupation …………………………………………………………….. 10. Family Status:- Father Mother Brother </p><p>Sister Other</p><p>11. Monthly Income …………………………………………………………. 12. Ambulatory/ NON Ambulatory …………………………………………. 13. Stand / NON Stand ………………………………………………………. 14. Wheel Chair ……………………………………………………………… A) Noramal</p><p>B) Poweer</p><p>15. Can you take help for any person to daily work ? If Yes Then Who Father Mother Brother </p><p>Sister Other</p><p>Note:- Send your two passport size Photo With this form. If you have another information use another paper. </p>