Earth Government
is hosting
Politics and Justice without borders
theme
The Global Constitution
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Earth Government
Politics and Justice without borders theme The Global Constitution
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Participants to the Global Dialogue 2005 must register.
There are no registration fees. One registration per form.
Ms. Mr. Mrs. Dr. First name: ________________________________________ Last Name: _____________________________ __________________________________________________________________________________________ Title/Position: ______________________________________ Department: ____________________________ Organization: ______________________________________________________________________________ Address (street number and name): __________________________________________________________________________________ City: ____________________________________________________________ Province/Territory: _________________________________________________ Country: _________________________________________________________ Postal Code: _____________________________________________________ Telephone: _______________________________ ext: _______________ Fax: ________________________ E-mail: __________________________________________________ Website: _________________________________________________ Sector: Federal Government Provincial Government Municipal Government Corporate Academic NGO Media Student Other (please specify): ____________________________________________________________________
Are you making a presentation? Yes
 No
If yes, title of presentation:_________________________________________________ Short summary: _________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Are you organizing a Workshop Session in your community? Yes No
____________________________________________________________________ If yes, do you need help other than monetary help? Contact us if needed. Describe your Worksho Session (goal, issue(s), place, participants, day and time, results, recommendations, etc.): ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Do you wish to participate in a Discussion Roundtable on Internet? Yes No
What issue(s)? ____________________________________________________________________ ____________________________________________________________________
Contact information
Germain Dufour
Project Officer Telephone (250)- 754-0778 Postal address Global Dialogue 2005 186 Bowlsby Street, Nanaimo, BC, Canada V9R 5K1 Electronic mail General Information: GlobalConstitution@telus.net Webmaster: gdufour@globalcommunitywebnet.com websites: http://globalcommunitywebnet.com/GlobalConstitution/egindex.htm http://globalcommunitywebnet.com/gdufour/ http://www.globalcommunitywebnet.com/globalcommunity/ Back to top of the page
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