ASSOCIATE MEMBERSHIP APPLICATION FORM ASSOCIATE MEMBERSHIP APPLICATION FORM Personal Information * Personal Information First Name First Name Last Name Last Name Contact Information * Physical Address Country * City * E-mail Address * Telephone Number Occupation/Field of Interest * Areas of Interest within WoPCAA (Select all that apply) * Environment Climate Change Health Peace and Security Legal Energy Water Skills or Expertise * Previous Involvement in Similar Initiatives or Organizations * Why do you want to become an associate member of WoPCAA? (Max 200 words) * What specific contributions or ideas do you have for WoPCAA's initiatives? (Max 200 words) * Availability for Associate Member Activities * Number of Hours Available per Month Preferred Days/Time for Activities * Preferred Days/Time for Activities Days Days Time Time Provide the contact information of one personal or professional reference * Provide the contact information of one personal or professional reference First Name First Name Last Name Last Name E-mail Address * Telephone Number Declaration I affirm that the information provided in this application is accurate to the best of my knowledge. I am committed to actively participating as an associate member and contributing to WoPCAA's mission. Submit If you are human, leave this field blank.
