NAME OF THE BRANCH           :
`WBW’ CELEBRATION PERIOD:

OFFICE BEARERS DURING      :                President:
THE PERIOD UNDER REPORT:                  Secretary:         
                                                                       Treasurer:

CATEGORY FOR EVALUATION               1) Branch based at Metropolitan City
(ONLY FOR LOCAL BRANCHES)             2) Branch having medical college in its area
                                                                       3) Branch without medical college in its area

  MEMBERSHIP STRENGTH                    TOTAL

i)                     Fellow

ii)                   Life

iii)                  Associate Life

iv)                  Student

v)                    Ordinary

vi)                  Associate

1.       State whether involvement of IAP members was sought and program organized.

2.       State whether para-medical personnel were involved in the `WBW’ and program organized.

3.       State whether medical college was involved in `WBW’.

4.       State whether local leaders (political, religious, social) were involved in `WBW’ and program organized.

5.       State whether work places like offices, factories or other establishments employing women were involved and program organized.

6.       State whether nursing mothers were involved in `WBW’ and program organized.

7.       State whether schools/colleges were involved in `WBW’ and program organized.

8.       State involvement of professional/service organization in `WBW’ and program organized

9.       State involvement of your branch with Government / WHO / UNICEF in `WBW’ and program organized.

10.   State media coverage given for `WBW’ and program organized/covered.

11.   State the action taken to promote IMS Act, 1992 and program organized.