Name of organisation

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Purpose and area of experience (e.g., environmental conservation, human rights, services, etc...):

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Do you work with/for a mobile indigenous community? If so, which one? Is it a Member of WAMIP?

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If not, what type of relationship do you have with mobile indigenous communities? Please describe:

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Do you have record of work on indigenous issues and/or mobility issues? If so, please describe:

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What countries and/or regions are relevant for your experience (please list them):

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How were you informed about the World Alliance of Mobile Indigenous Peoples?

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

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Are any members of WAMIP supporting your application? If so, please list them:

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E‐mail address (where to send you WAMIP mail):

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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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