CONFIDENTIAL • FOR MEMBERS & NEW JOINERS

Member Registration & Profile Update

Comprehensive profile form for all new and existing members of The Indian Stammering Association (TISA).

1. Personal Information

Full Name (As per official records)

Date of Birth

Gender

Primary Email Address

We'll send confirmation here

Mobile Phone Number

+91

10-digit Indian mobile number

Membership Type

Are you a new Member?

2. Professional Information

Highest Educational Qualification

Current Profession / Occupation Status

Primary Profession / Industry Sector

3. Residential Information

State of Residence (India)

City / District of Residence

Helps us connect you with local SHG

Full Residential Address

This helps us connect you with local SHGs and events near you.

4. Identity Verification (Recommended)

Upload a Valid Government Identification Proof

Click to upload or drag & drop

JPG, PNG or PDF • Max 10 MB

Aadhaar, Passport, Voter ID, Driving License etc. (for verification & trust building)

5. Your TISA Journey & Involvement *

Have you completed the TISA Foundations Program (TFP) - TISA's free structured course?

Yes, I have completed

No, not yet

How many TISA National Conferences have you attended?

How many Tisa Communication Workshops have you attended?

Have you been actively involved in volunteering roles for TISA?

Are you currently part of a local Self-Help Group (SHG) associated with TISA?

Yes

About Your Stammering

Your stammering difficulties on a scale of 0 to 10

What have you done for your stammering?

6. Additional Information (Optional)

Please share any other information that the core team should be aware of

This could include technical skills, willingness to help in specific cities, feedback, etc.

Your privacy is important. All information submitted through this form is kept strictly confidential and used only for internal TISA coordination, event planning, and connecting members with local support. We never share your data with third parties.

You can use this same form later to update your profile. Our team reviews every submission personally.

Member Registration & Profile Update

Please fix the following issues:

Thank You!