Cacao Industry Development Association of Mindanao Inc.

Linking Cocoa Industry Stakeholders for Sustainable Growth

MEMBERSHIP APPLICATION

A. PERSONAL INFORMATION
Name :
Address:
Gender:

Marital Status:

Birthday:

Birth Place

Mobile No./Landline:

E-mail:

B. BUSINESS/ORGANIZATION
Name of Business/Organization:
Bus./Org. Contact No.:

Email:

Purpose of Joining in CIDAMi:

Type of Business/operation
Nursery Operator Capacity: _______________

Location: ___________________

Grower No. of has: ______ No of trees: _______

Location: ___________________

Trader/Consolidator

Market: ____________________

Volume: ______________

Processor Type of products: ________________

Volume: ___________________
Market: Global
Domestic
Input Supplier Type of Products: __________________________________________
Service Provider
-Academe
-Researcher

-Plant breeder
-Agriculturist

-Laboratory
-Plant Technician

Others: ___________________________________________________________
How did you know about CIDAMi or who referred you?
_________________________________
Applicant Signature/Date
_________________________________CIDAMi USED ONLY___________________________________

Evaluated by: __________________________

Approved by: __________________________