Membership Form

Name of Organisation:
Organization's Acronym:
Year Founded (inc. Month)
Where the Organisation is Registered:
Organisation's Registered Number: (if applicable)
Scope of Organisation:
Organisation Type:
If You Selected "Other" Please Specify:
Areas of Interest:	Agriculture Children Climate Change Criminal Justice Culture Environment Education Health Human Rights Labour Media & Communications Social Development Women Rights Youth
Mission or Description:
Numbers of Registered members:
Office Mailing Address:

City:
State/Province:
Country:
Postal/Zip:
Phone No.
Fax No.
Cell No.
Email:
Website:
Full Name:
Designation in Organisation:
Qualification:
What is your Occupation: