Gaia Association- Ethiopia Offers Request to Join General Assembly

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Gaia Association- Ethiopia Offers Request to Join General Assembly

April 4, 2012

The General Assembly is a group of individuals committed to supporting Gaia Association’s mission to improve lives, the environment and the well-being of families with clean and safe ethanol cookstoves and fuel.

The General Assembly meets once per year in Addis Ababa and members would be available for additional meetings on an as-needed basis.

Members must be able to be physically present at the meetings in Addis Ababa, Ethiopia.

If interested, please see the Membership Request Form below and return to the Gaia Association.

Thank you!

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GENERAL ASSEMBLY MEMBERSHIP REQUEST FORM

Gaia Association – Addis Ababa, Ethiopia

PERSONAL INFORMATION:-Name: ________________________________________________________________________

Nationality: ___________________________________________________________________

Current Address: _______________________________________________________________

Email Address: _________________________________________________________________

Phone Number: ________________________________________________________________

EDUCATIONAL BACK GROUND:-

 

NAME OF THE ORGANIZATION:-

 

POSITION:-

 

 

 

MEMBERSHIP INFORMATION:-

Membership in Any Resident Charity:_______________________________________________

Nature of the Organization: _______________________________________________________

_____________________________________________________________________________

For how long: __________________________________________________________________

REASON FOR JOINING THE ORGANIZATION GA:-

SIGNATURE:-I authorize the verification of the information provided on this form as to my recognition. I have received a copy of this application.

Signature of applicant:                                               Date:

Note: Membership is activated only when membership application is approved by the General Assembly members.

 

For more information, contact the Gaia Association at gaiaassociation@ethionet.et

Gaia Association
Bole Sub city, Wereda 17, Kebele 23
House No 2003, P.O. Box 1460 code 1250
Addis Ababa, Ethiopia
Telephone + (251) 11 6 183540
Fax +251 11 662 74 02

To download a PDF of this form please visit: http://www.scribd.com/doc/87980874/Gaia-General-Assembly-Membership-Request-Form