signupformfornewcoalitions.docVIP

Sign up Form for new coalitions The information requested in this form is to enable the PWYP Global Steering Committee to properly assess and ensure that all affiliated coalitions reflect the Values, Operating Principles and Vision to which we as a global network have all committed to uphold. Please complete the form, providing as much information as possible in your answers. We thank you for your cooperation and understanding. The completed form, along with the other requested supplementary documents (see Coalition Application Checklist), should be handed over to a staff member of the PWYP International Secretariat, or sent to: Publish What You Pay International Secretariat c/o Open Society Foundation, 7th Floor, Millbank Tower, 21-24 Millbank, London SW1P 4QP, UK Scanned copies by email to: info@ or faxed to: +44 20 7031 0201 Section I: Key Contact information Contact Person Name (for application process) Title / Organisation: Position within Coalition: Email: Mobile: Telephone: Name of Coalition (in full) Acronym (if any) Alternative contact (plus title / organisation): Title / Organisation: Position within Coalition: Email: Mobile: Telephone: Coalition’s contact information Mailing Address Physical address (if different) Telephone(s) Fax Website Section II: Coalition Identity, Vision and Mission Please use the space below to summarise briefly the history and establishment of the coalition (100 words max.) Date coalition established (MM/YY): Working language(s): Coalition member organisations: Please provide us with a list of members on a separate sheet (see excel format annexed), including the name, type of organization (i.e. NGO, CBO, Faith-based organization, media, etc.), the main sectors and location(s) of their engagement (country, regions or provinces), a contact person including email and telephone, website (if available). Please list any other regional or national networks, coalitions, associatio