Name of mobile indigenous community:

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Language(s) spoken:

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Country or region of reference:

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Is the mobile indigenous group a subdivision of a larger people? If so, please describe:

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Please briefly describe the living area and resource tenure system:

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Please describe whether/ mobility is crucial for the livelihoods, cultural identity and sustainable use of natural resources and why:

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Please briefly describe the customary leadership (if applicable):

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What are the key objectives that the community would like to achieve through the membership in WAMIP?

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Please indicate how (through which channels) do you expect that the community and /or its customary leadership will be kept informed of WAMIP initiatives and will communicate their relevant decisions:

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If applicable, e‐mail address (where to send WAMIP mail on behalf of the group completing this form):

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Name of Contact Person:

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Postal address (where to send WAMIP publications on behalf of the group completing this form): Address line 1:

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Address line 2:

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Address line 3:

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Postal code:

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City:

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Country:

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Telephone:

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Fax:

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Today’s Date:

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Please add any other comment, information or suggestion you may judge relevant:

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Please indicate the name (s) of the person (s) or organisation that has facilitated and witnessed the membership ratification process and completed this form:

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