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Organization Application Form
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Membership Type
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Please select your Membership type from the list
Select Membership type
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| Years |
Year is a required field
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| Membership Fee |
Receive 5% Discount for 2 years payment /
Receive 10% Discount for 3 years and more payment
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Organization Details |
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Organization Name* |
Organisation Name is a required field
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Generic Email Address * |
Email is a required field
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Alternative Email Address * |
Email is a required field
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Postal Address
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Postal/Zip Code
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Zip Code is a required field
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City * |
City is a required field
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Country *
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Country is a required field
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Telephone * |
Please include the dialing area code
Telephone is a required field
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Fax |
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Organisation Profile |
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Organisation Profile (including mission/vision): *
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Organisation Profile is a required field
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Website:
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Social Network(s) |
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Facebook |
LinkedIn |
Twitter |
| Type of Organization |
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Organisation type is a required field
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| Organisation Geographic Reach |
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| Geographic Area Where Your Organisation Is Active |
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Hold down the Ctrl button to select more than one item
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Areas of Work/Interest
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Hold down the Ctrl button to select more than one item Other, specify :
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Communications
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What kinds of information would you like to recieve from CIVICUS
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Hold down the Ctrl button to select more than one item
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Preferred Language |
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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.
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Select your Preferred Language
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Other Spoken Languages
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Other :
Hold down the Ctrl button to select more than one item
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Subscriptions
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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
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CIVICUS Mission, Vision and Policy *
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I have read and understand CIVICUS' Mission and Vision
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I have read and understand CIVICUS' Membership Policy
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Disclaimer - Privacy Policy
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Yes, I would like to share my contact details within the CIVICUS network
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Yes, I want you to feature me on the CIVICUS website
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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
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| Details of Primary Contact |
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Please provide contact details of the person we should contact on a regular basis, including for membership renewal and update of your organizational information.
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Title / Prefix * |
Title is a required field
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First Name * |
First name is a required field
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Last Name * |
Last name is a required field
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Gender
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Gender is a required field
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Job Title
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| Telephone *
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Telephone is a required field
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| Email Address * |
Contact Email is a required field
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Verification Documents
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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)
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Financial Statements * |
Financial statements are required
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| Certificate of Registration * |
Certificate of registration is required
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| Annual Reports * |
Annual Reports are required
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| References * |
References are required
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| Organisation Logo * |
Organisation Logo is required
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Confirmation
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