Associate to nrg4SD Application Form

Network of Regional Governments
for Sustainable Development
Associate to nrg4SD
Application Form
The Network of Regional Governments for Sustainable Development, nrg4SD, is primarily an organisation
representing subnational governments/regions and associations of subnational governments/regions.
The statutes of nrg4SD also foresee the category of associate.
Associate members are interested parties such as non-governmental organisations, universities and
academic institutions, trade unions, employers’ associations and other associations/groupings
committed ti sustainable development who accept the nrg4SD Founding Declaration of Gauteng and the
payment of an annual fee. Associate members will be heard but have no voting rights.
Once the forms dully completed are received, the Steering Committee of nrg4SD will examine the
application. Following from the positive recommendation of the Steering Committee, the General
Assembly of nrg4SD ratifies the accession of the new associate.
Forms dully completed should be returned to
nrg4SD Secretariat
For the attention of Ms Natalia Vera – Internal Affairs Coordinator for nrg4SD Secretariat
227 Rue de la Loi/Wetstraat
B-1040 Brussels - Belgium
Tel.: +32 (0) 475 844 339/ +34 653 221968
Email: nrg4sd@nrg4sd.org and nvera@nrg4sd.org
nrg4SD | 227 Rue de la Loi/Wetstraat | B-1040 Brussels, Belgium
Tel. +32 (0) 475 844 339 – nrg4sd@nrg4sd.org - www.nrg4sd.org

Network of Regional Governments
for Sustainable Development
Declaration of associate application
I, the undersigned
____(title)_____________________(first name)_____________________________ ________(last name)
______________________________________________________________________________(job title)
____________________________________________________________________________(address)
_____________________________________________________________________________________
_____________________________________________________________________________________
________________________________________________________(telephone, fax, e-mail, website)
representing (name of entity) ____________________________________________
and accepting the principles set out for nrg4SD iin the Gauteng Declaration adopted in Johannesburg on
31 August 2002, ask that my entity becomes an associate of nrg4SD and nominate the following person
as our contact point for nrg4SD day to day affairs:
___(title)_______________________(first name)____________________________(last name)
____________________________________________________________________________(job title)
____________________________________________________________________________(address)
_____________________________________________________________________________________
_____________________________________________________________________________________
___________________________________________________________(telephone, fax, e-mail, website).
I acknowledge the annual financial contribution asked from associates and declare that we will be
making a contribution of __________________ euros €.
Signed:
Date:
nrg4SD | 227 Rue de la Loi/Wetstraat | B-1040 Brussels, Belgium
Tel. +32 (0) 475 844 339 – nrg4sd@nrg4sd.org - www.nrg4sd.org