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promoting a global perspective |
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APPLICATION FORM
1. NAME OF ORGANISATION:
2. PHYSICAL ADDRESS:
3. TELEPHONE NUMBER/ FAX ( please include country and city codes)
4. EMAIL ADDRESS:
5. DOES YOUR ORGANISATION HAVE A WEBSITE? IF IT DOES, PLEASE PROVIDE THE ADDRESS:
6.1 NAME, (TITLE EG. DR/ PROF/ MS, SURNAME, FORENAME/S)
CAPACITY AND CONTACT DETAILS (OFFICE AND HOME) OF STAFF MEMBER TO ATTEND CONFERENCE: ________________________________________________________ ________________________________________________________
________________________________________________________ ________________________________________________________ ________________________________________________________ ____________________
6.2 GENDER AND AGE:
7. PLEASE TICK LANGUAGE PREFERENCE:
ENGLISH FRENCH PORTUGUESE ARABIC
8. DESCRIBE STAFF COMPOSITION IN TERMS OF TOTAL NUMBER OF STAFF, GENDER BREAKDOWN AND REGIONAL DIVERSITY ( if applicable):
9. LIST AND DESCRIBE THE ACTIVITIES AND PROGRAMMES OF YOUR ORGANISATION THAT ARE RELEVANT TO ONE OR MORE OF THE FIVE THEMES OF THE WORLD CONFERENCE:
10. WHAT IS THE GEOGRAPHICAL FOCUS OF THE ABOVE
11. IS YOUR ORGANISATION ACTIVE INTERNATIONALLY? IF YES, DESCRIBE THE ACTIVITIES:
12. IS YOUR ORGANISATION A MEMBER OF A REGIONAL NETWORK? IF YES, STATE WHICH:
13. DOES YOUR ORGANISATION HAVE CONSULTATIVE STATUS WITH:
a) ECOSOC
b) THE AFRICAN COMMISSION ON HUMAN AND PEOPLE'S RIGHTS
13. PLEASE SUBMIT ADDITIONAL COMMENTS IF ANY:
*** We advise that selected organisations should have at least one other standby participant with full visa and other travel requirements at their disposal. In the event that the selected participant is unable to travel the standby may more readily be substituted.
**** PLEASE NOTE THAT THE SUBMISSION OF THIS FORM MUST BE SUBMITTED TOGETHER WITH THE APPLICATION FORMS FOR ACCREDITATION FOR YOUR ORGANISATION TO BE PERMITTED TO PARTICIPATE IN THE DAKAR REGIONAL MEETING AND IN THE WORLD CONFERENCE IN DURBAN – SOUTH AFRICA.
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