MEMBERSHIP REGISTRATION form APPLICANT'S DETAILS Name of Organization * Year Founded * Is the organization formally registered: * Yes No Operational Language used: *FrenchPortugueseEnglish Physical Address * Official Telephone * Official Email * Contact Person Sex * Male Female First Name * Middle Name Last Name * Position * Email * Telephone * Mobile AREA(S) OF ACTIVITY AND INTEREST Please check a maximum of up to three main areas of activity and specialty (where available, kindly provide appropriate evidence in the form of relevant reports or other evidences of your organization’s work: Agriculture, Nutrition and Food SecurityGood Governance, Democratization and Public PolicyEnvironment and Climate ChangeIntra-Regional Trade, Natural Resources and Economic DevelopmentMigration and EmploymentStability, Peace and SecurityHealthcare, Humanitarian Emergencies and Social DevelopmentHuman rights and Transitional JusticeEducation, Infrastructure and Technology Others: Please check any cross-cutting themes that interest your organization: Women and Gender issuesYouth EngagementPeople Living with Disability Others: Would you like to refer other organizations? Please provide the names and contacts of 3 of your NSA partners that you would like to recommend for membership in the coalition (we would inform them that you: Name of Organization: Contact Person Male Female Title: Dr. Mr. Mrs. Ms. Prof. Others: First Name: Middle Name Last Name Position Email: Telephone (WhatsApp) Fax: Name of Organization: Contact Person Male Female Title: Dr. Mr. Mrs. Ms. Prof. Others: First Name: Middle Name Last Name Position Email: Telephone (WhatsApp) Fax: WACSOF Newsletters I wish to be kept informed of the work of WACSOF by receiving the Forum’s Newsletter and email Updates. Yes No Consent Please tick the box below to give your consent for the name of your organization to be listed in WACSOF’s membership directory online and in WACSOF’s publications: Yes No Submit
