Organization Application Form 
Membership Type Please select your Membership type from the list  
Years  
Membership Fee

Receive 5% Discount for 2 years payment / Receive 10% Discount for 3 years and more payment

Organization Details
Organization Name*  
Generic Email Address  *  
Alternative Email Address  *  
Postal Address
Postal/Zip Code *  
City   *  
Country   *

 
Telephone    *
Please include the dialing area code  
Fax   
Organisation Profile
Organisation Profile (including mission/vision): *  
Website:
Social Network(s)
Facebook   LinkedIn  Twitter 
Type of Organization
 
Organisation Geographic Reach
Geographic Area Where Your Organisation Is Active
 

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Areas of Work/Interest

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Other, specify :
Communications
What kinds of information would you like to recieve from CIVICUS

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Preferred Language
Please select the language you are most comfortable communicating in. The Civicus Secretariat may also occasionally send you emails and other forms of communication in this language.
 
Other Spoken Languages
Other :

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Subscriptions
e-CIVICUS - Our weekly electronic newsletter keeping thousands of people and organizations informed of the developments that are taking place in civil society around the world
CIVICUS Mission, Vision and Policy *
I have read and understand CIVICUS' Mission and Vision  *
I have read and understand CIVICUS' Membership Policy  *
Disclaimer - Privacy Policy
Yes, I would like to share my contact details within the CIVICUS network
Yes, I want you to feature me on the CIVICUS website
We will never make your contact details available outside of CIVICUS Network. We will only contact you according to the selections you have made above. See our Privacy Policy
Details of Primary Contact

Please provide contact details of the person we should contact on a regular basis, including for membership renewal and update of your organizational information.

Title / Prefix  *  
First Name  *  
Last Name  *  
Gender  
Job Title
Telephone *  
Email Address   *  
Verification Documents

Verification documents required are : Financial Statements, Certificate of Registration, Annual Reports, References and Organisational Logo (As part of your member profile, we would like to include a logo for your organisation. Please provide a jpeg or png file of your logo, with dimensions no smaller than 75 X 75 pixels(px) and below a maximum file size of 1 Megabyte(1MB)

Financial Statements *  
Certificate of Registration *  
Annual Reports *  
References *  
Organisation Logo *  
Confirmation