RI-Membership-Application-form

RI is a global network promoting and implementing the rights and inclusion of people with disabilities Application for Membership

Please print or type the following:
Name of Organization*
Mailing Address*
City*
State*
Country*
Telephone*
Format: +0 (000) 000-0000.
Fax*
Email*
example@example.com
Name and address of the Principal Executive Officer of your organization Executive Director etc*
Membership Category Requested (for a description of the different membership categories, please see pages B1-B2 of the RI Membership By-Laws): An organization applying to be an NMO needs the approval of the existing NMO and RI National Secretary in their country. National Member Organization (NMO)Associated Member Organization (AMO) International Member Organization (IMO)Individual Corresponding Member*

National Member Organization (NMO)International Member Organization (IMO)Associated Member Organization (AMO)Individual Corresponding Member
Date Organization was founded*

MonthDayYear
Date
Legal status and name of Law under which organized*
Representative from your organization to RI: (each country with at least one NMO's can nominate an RI National Secretary. If there are more than one NMO in your country you have to agree on who should be the National Secretary. If your country does not have a National Secretary please contact the RI-Global Secretariat See page B-2 Rights & Privileges
Name Address of your representative*
Please list name and address of your organizations appointments to the RI Standing Commissions and Subcommissions see page B2 Rights and Privileges page C1*
Is your organization?*

NationalLocalInternational
Is your organization a: (if needed please explain) Federation of organizations Single organization
Is your organization a:*

Federation of organizationsSingle organization
Does your organization have chapters or branches If yes please list names and addresses*
What is your main policy making body eg Council Executive Committee or Board of Directors*
What is the policy of your organization with regard to the participation of people with disabilities in governance and policymaking*
Does your constitution stipulate that certain groups should be represented on the board? e.g. government representatives.*
How many employed staff does your organization have*
How many volunteers approximately are involved*
Where are volunteers serving:*

on your policy making bodyto support staff workto provide direct serviceother (please specify)
List any other organizations national regional or international with which your organization is affiliated attach separate sheet if necessary*
Does your organization give direct service to individuals?*

YESNO
How is your organization financed? (if possible give percentage of funding source)*

Contribution from the publicPayment for serviceMembership feeGovernment subsidyOther (please describe)
Please describe the purpose of your organization.*
What have been the principal achievements in your organizations program during the past two years?*
What are your organizations plans for program and development during the next two years?*
What international projects technical assistance programs or exchange programs is your organization associated with?*
What is the population of the area served by your organization if relevant
Does your organization work with people with specific disability? If so specify:*

PhysicalCognitivePsychosocialCommunicationOther (please specify):
Who uses your services :*

Children with disabilities and their familiesAdults with disabilitiesProfessionals in the Disability fieldOrganizations working with people with different kinds of disabilitiesOther (please specify):
Do you have an on-going publishing program? (please specify and attach additional sheet if necessary)
Periodicals
Proceedings
Research reports
Website
Is your organization working with the United Nations or any of its agencies If so which ones*
Please rank these priority areas according to their importance to the work of your organization. 1=high; 2=medium; 3=low; 4= not applicable
Advocacy and the rights and inclusion of people with disabilities*

1

2

3

4

1 is High, 4 is Low
Legislation and social policy*

1

2

3

4

1 is High, 4 is Low
Accessibility*

1

2

3

4

1 is High, 4 is Low
Assistive technology*

1

2

3

4

1 is High, 4 is Low
Information services*

1

2

3

4

1 is High, 4 is Low
Employment*

1

2

3

4

1 is High, 4 is Low
Education of children and youths with disabilities*

1

2

3

4

1 is High, 4 is Low
Leisure, Recreation and Physical activities*

1

2

3

4

1 is High, 4 is Low
Prevention of disabilities *

1

2

3

4

1 is High, 4 is Low
In which of the following ongoing activities of RI does your organization plan to be actively involved in?*

RI Global meetingsRI Regional meetingsMainly domestic activitiesTechnical activities, e.g. RI CommissionsSpecial Programs
Please describe what your organization can offer RI*
Please describe how your organization expects to benefit from association with RI. Attach additional sheet if necessary.*
Title position*
Date*

MonthDayYear
Date
Signature*
Should be Empty: