Medan Steering Committee Meeting - 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:
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