Medan Steering Committee Meeting - nrg4sd.org

Network of Regional Governments
for Sustainable Development
Full membership to nrg4SD
Application Form
All subnational governments/regions and associations of subnational governments/regions who accept
the nrg4SD Founding Declaration of Gauteng and the payment of an annual fee can apply for
membership to nrg4SD.
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 member.
Forms dully completed should be returned to:
nrg4SD Secretariat
For the attention of Ms Maruxa Cardama – Secretary General
227 Rue de la Loi/Wetstraat
B-1040 Brussels - Belgium
Tel.: +32 (0) 475 844 339
Email: nrg4sd@nrg4sd.org and mcardama@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 membership application
I, the undersigned
____(title)_____________________(first name)_____________________________ ________(last name)
______________________________________________________________________________(job title)
________________________________________________________________________(address)
_____________________________________________________________________________________
_____________________________________________________________________________________
________________________________________________________(telephone, fax, e-mail, website)
representing the Government of___________________________________________________________
/the Association of Governments called_____________________________________________________
being a Government, or an Association which represents Governments, immediately below the UN
represented nation state and accepting the principles set out for nrg4SD iin the Gauteng Declaration
adopted in Johannesburg on 31 August 2002, ask that my Government/Association of Governments
becomes a member of nrg4SD and nominate the following person as our contact point for 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 members and declare that we will be making
a contribution of __________________ euros € based on our population of __________ inhabitants and
our GDP 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