Earth Government Politics and Justice without borders theme The Global Constitution
Participants to the Global Dialogue 2005 must register.
There are no registration fees. One registration per form. Register by email at: GlobalConstitution@telus.net
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): ____________________________________________________________________
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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/
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