IPRI Affiliates Form

IPRI Affiliates Form
Name of Organization*
Country*
Region*
Nature of the organization (Mark which is most appropriate for your organization)*

Community based or grassroots organizationIndigenous organization with multi-sectoral constituents ( mix of women, youth, elders, etc)Indigenous network/ AllianceCustomary institutionIndigenous peoples’ led Institution/NGOSectoral ( ie women, youth, persons with disabilities, elders )Other
Geographical Coverage (Mark which is most appropriate for your organization)*

Local level (village)District levelProvincial levelSubnational level (working in different states/provinces)National levelRegional alliance/ network (3-4 countries in one region)Global alliance/ network (at least 1member organization in at least 4 IP regions)
Relevant activities or programme of the organization/ network/ institution related criminalization and upholding indigenous peoples rights and fundamental freedoms against violations and impunity ( maximum of 100 words)*

0/100
List down the specific indigenous peoples groups your organization is working with (click the + button to add more):
Contact Details of the Organization
Address of he organization*
Phone Number*
Fax
Email Address (organizational email):*
example@example.com
Website (if any)
Organizational Social Media Accounts (Facebook, Twitter, etc)

FacebookTwitterInstagramLinkedInOther (indicate which social media)
Facebook
Twitter
Instagram
LinkedIn
Other Social Media
Contact Persons
Head of the Organization
Name

First NameLast Name
Gender
Position
Email
example@example.com
Phone Number*
Skype
CONTACT PERSON OF THE ORGANIZATION FOR IPRI COORDINATION
Name

First NameLast Name
Gender
Position
Email
example@example.com
Phone Number*
Skype
Should be Empty:

IPRI Affiliates Form

Contact Details of the Organization

Contact Persons

Head of the Organization

CONTACT PERSON OF THE ORGANIZATION FOR IPRI COORDINATION