IYPN Membership Form • Name: • Work Address: • Home Address • Contact information Email Telephone Fax Website • Membership annual dues information: $10 flat annual fee + your active participation in your area of speciality • Area of Speciality Goal 1: Eradicate extreme poverty and hunger Physician, Economist, Scientist, Engineer, Social Scientist, Urban Planner, Architect Goal 2: Achieve universal primary education Professor, K 1-12 teacher Goal 3: Promote gender equality and empower women Gender Specialist, Human rights, and Social Scientist Goal 4: Reduce child mortality Gynecologist, Pediatric, Social Scientist Goal 5: Improve maternal health Gynecologist, Pediatric, Social Scientist Goal 6: Combat HIV/AIDS, malaria and other diseases Physician specilializing in HIV/AIDS, Malaria, TB and other diseases Goal 7: Ensure environmental sustainability Environmental Scientist, Environmental Engineer, Social Scientist Goal 8: Develop a global partnership for development Banker, Management, Finance, Corporate Social Responsibility • Your state of permanent residence in the United States Alabama State Alaska State Arizona State Arkansas State California State Colorado State Connecticut State Delaware State District of Columbia Florida State Georgia State Hawaii State Idaho State Illinois State Indiana State Iowa State Kansas State Kentucky State Louisiana State Maine State Maryland State Massachusetts State Michigan State Minnesota State Mississippi State Missouri State Montana State Nebraska State Nevada State New Hampshire State New Jersey State New Mexico State New York State North Carolina State North Dakota State Ohio State Oklahoma State Oregon State Pennsylvania State Rhode Island State South Carolina State South Dakota State Tennessee State Texas State Utah State Vermont State Virginia State Washington State West Virginia State Wisconsin State Wyoming State • Your home state in India* (The Union is made up of 28 states and 7 union territories*) Andaman&Nicobar Islands Andhra Pradesh* Arunachal Pradesh Assam Bihar Chandigarh* Chattisgarh Dadra and Nagar Haveli* Daman and Diu* Delhi* Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka Kerala Lakshadweep* Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa, Pondicherry* Punjab Rajasthan Sikkim Tamil Nadu Tripura, Uttaranchal Uttar Pradesh West Bengal • What would be interest to participate in IYPN other than your area of Specialiaty? Fundraising Organizing events in your state Representing IYPN local, national and internationally Liason between universities, corporations, and government agencies Newsletter editor Outreach person Focal point person in your state Focal point for a MDG goal Report writer Media person Government liason Project coordinator India Program coordinator & development