CDN GA 2014
Email Address *
Country of residence *
If your Nationality is different please note.
Residence address *
Mobile phone no. *
Home telephone no.
Emergency Phone no.
State phone number in case we cannot reach You.
Organisation naem, local and English
Role in Organisation
member, activist, volunteer, position
Organisation telephone no.
Give us a short description of your organisation (aims, activities, members)
Not a member
In case you're not affiliated with an organisation but define yourself as a member of a social movement or political group, please explain and motivate :
Please explain your motivation to take active part in preparation of this event
Please list and explain previous experience (if any) with the topics of this event
Please explain how do you think that you can contribute to the event with specific skills, topical knowledge, contacts, etc
Follow up & Multiplier effect *
Please explain and motivate the channels, means and places that you're willing to use the experience and knowledge you will gather during this event.
Do you have any dietary and/or accessibility requirements?
Your working languages:
By clicking the Submit button, I herewith confirm that the information given in this application are correct and that I will be available for all the planned event activities during the dates mentioned in the Call for Participants.