Article 59(1) Campaign Membership Form

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Membership Form:

Organization/Individual Details:

Name of Organization/Individual: *

Postal Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Email *

Website (if applicable)

Type of Registration (for organizations):

Country of Registration *

Registration Number *

Geographic Scope of Operations *

Affiliation *

Key Areas of Focus (e.g., Human Rights, Gender, SOGIE, etc.): *

Contact Person

Name *

First

Last

Position *

Phone *

Mobile *

Email *

Type of Membership

Organisational membership
Individual membership

Reasons for Joining the Article 59(1) Campaign: *

Prospective Contributions to the Article 59(1) Campaign: *

Consent and Declaration:

By submitting this form, I/we agree to actively participate in the Article 59(1) Campaign activities and commit to the values and objectives of the campaign.

Date *

Signature *

Clear Signature

Name of Individual Signing (for organizations): *

Designation: *

Article 59(1) Campaign Membership Form

Membership Form:

Organization/Individual Details:

Contact Person

Type of Membership

Consent and Declaration:

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Article 59(1) Campaign Membership Form

Membership Form:

Organization/Individual Details:

Contact Person

Type of Membership

Consent and Declaration:

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