World Movement for Democracy

World Movement Participants Database - Information Form - Print-Ready

If you wish to post information about your organization print the following form, fill in the information, and fax it to (+1-202-378-9889).

A red asterisk * indicates a required item.

IMPORTANT! You must select one of the following:

___ Include information about my organization in the World Movement database.
___ Do not include any information about my organization in the World Movement database.
___ Do not include information about my organization in the World Movement database, but include my organization in all e-mail communications of the World Movement.
___ Update information about my organization in the World Movement database.

1. Organizational Information
Name of Organization:	__________________________________________ *
Acronym:	__________________ (if applicable)
Contact Person/Title:	___________________________________________ *
Primary
Address:	___________________________________________ *
	___________________________________________ *
Country:	___________________________________________ *
Phone:	___________________________________________ *
Fax:	___________________________________________ *
Email:	___________________________________________ *
Web site:	___________________________________________ *
Secondary
Address:	___________________________________________ *
	___________________________________________ *
Country:	___________________________________________ *
Phone:	___________________________________________ *
Fax:	___________________________________________ *
Email:	___________________________________________ *
Web site:	___________________________________________ *
Disclosure
Indicate below any information that may pose a risk to your organization or staff and that you do not want included in the database. Examples: address, telephone number, e-mail address, etc.
_______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

2. Mission Statement *
Provide your organization's mission statement in 2-3 sentences.
_______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

3. Topical Focus *
Please check the areas of democracy work in which your organization is active.
___ Civic Education ___ Civil-Military Relations ___ Civil Society Strengthening ___ Conflict Resolution and Transitional Justice ___ Constitutionalism and Institution Building ___ Decentralization and Local Governance ___ Democracy Research and Public Opinion ___ Developing Nonviolent Tactics ___ Economic Reform and the Business Sector ___ Economic and Social Rights ___ Elections ___ Freedom of Information	___ Gender Issues and Sexual Minority Rights ___ Good Governance, Transparency, and Anti-Corruption ___ Human Rights, Equality, and Access to Justice ___ Labor Unions and Worker Rights ___ Legislative Development and Assistance ___ Media, Freedom of Expression, and Communication Technology ___ Political Parties and Political Leadership ___ Role of International Institutions ___ Rule of Law and Judicial Independence ___ Tolerance and Religious Freedom ___ Young People's Political and Civic Participation

4. Geographical Area of Focus *
Please indicate a region and/or country in which your organization works. Country: ___________________________________________________________ * Regional: * ___ Africa ___ Central/Eastern Europe and Eurasia ___ Canada and the United States ___ Global ___ Latin America and the Caribbean ___ Middle East and North Africa ___ South, East, and Pacific Asia ___ Western Europe

5. Activities *
Check the types of activities that your organization conducts. ___ Advocacy ___ Election Monitoring ___ Human Rights Monitoring ___ Publication ___ Research ___ Regularly scheduled events (conferences or workshop series) ___ Training ___ Other: ______________________________________________________

6. Publications

List up to five (5) publications, such as newsletters, journals, book series, handbooks, and manuals, produced by your organization.

Publication Title: __________________________________________________________
Web site (if available): ______________________________________________________

Publication Title: __________________________________________________________
Web site (if available): ______________________________________________________

Publication Title: __________________________________________________________
Web site (if available): ______________________________________________________

Publication Title: __________________________________________________________
Web site (if available): ______________________________________________________

Publication Title: __________________________________________________________
Web site (if available): ______________________________________________________

7. Training/Conferences/Events
Please indicate regularly scheduled events, such as annual conferences, training programs, or monthly workshops.
_______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

8. Assemblies
Please indicate World Movement for Democracy assemblies attended by your organization. ___ Istanbul, Turkey (2006) ___ Durban, South Africa (2004) ___ São Paulo, Brazil (2000) ___ New Delhi, India (1999)

9. Comments/Suggestions
Your comments and suggestions will help us to develop the participants database and World Movement Web site to make them as useful as possible. (How would you best use the Web site? What would you most like to gain from it? What kind of information can help your organization to network with others?)
_______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________