Info: WWSOSA Members and Faith Action to End GBF Participants

Submitted by Jan on Tue, 10/30/2018 - 12:21

You can complete this form as a member of We Will Speak Out SA, as a participant in "Faith Action to End GBV," as a survivor of gender-based violence, or as one of the champions of a survivor group - please tick all that apply. *

Individual/Individual WWSOSA Member

Representative of an Organisational WWSOSA Member

Survivor Champion (Leaders of Survivor Groups)

Survivor of Sexual or Genderbased Violence (If you are willing to share)

Technical Partner/Specialist Organisations, not faith-based

Participant in the Faith in Action against GBV Collective

Personal Details

Please enter your personal information.

Fields with a red * are required information.

Your Title *

First name *

The name you are called by

Middle name

Last name *

Your last name/Surname

Your Date of Birth

Month

Day

Year

Your Primary E-mail

Type "none" if you do not have an e-mail address

Your Secondary E-mail (If relevant)

Type "none" if you do not have an e-mail address

Province

Province/State

By clicking "accept": I/We agree that my information may be used only for WWSOSA or "Faith Action Against GBV information sharing and newsletters. My information will not be used in any other way. If I submit this information as individual or organisational member: - I (as individual)/We (as organisation) recognise the WWSOSA values, endorse the positions set out in the membership document & commit to play an active role in the coalition. - I/We hereby acknowledge and accept that in the event of being recorded in any way by WWSOSA or Faith Action against GBV, I/We: - Allow WWSOSA or Faith Action against GBV to use the photograph/film/audio recording/interview at its discretion; - Do not hold any rights to it, and I/We will receive no remuneration for the photograph/film/recording/interview, nor have editing rights over it.

Accept *

Decline

Please Add More Information

The information you shared is the minimum we need in order to share information with you. However, one of the challenges we experience when dealing with sexual- and gender-based violence is that we do not know who is doing what, and where! This often means that we work in isolation and reinvent the wheel - reducing our impact.

As faith-based organisations it would be very helpful if we could know what others are doing so that we are able to collaborate and refer those in need to the correct organisation. We might even need partners for shared proposals or responses to challenges. In order to do this, we need a more comprehensive database.

We would really value it if you can share more information in the sections below.

the first section gives a bit more information about you
if you represent an organisation, the second section provides more organisational information.
The third section provides info about the focus areas and services you or the organisation provide.

Completeting the forms will be quite quick, but very helpful!

Additional Personal Details (Optional)

This information is optional but very helpful!

Sex

With which sex do you identify?

Address 1

Building/Unit name

Address 2

Street name and number

Address 3

Suburb

Country

Postal Code

Telephone Number

Number where you can be contacted (Include country and area code) and do not use spaces.

Cellphone Number

Cellphone number - please include the country code, remove the first "0" of your number and do not use spaces For South Africa: eg 270832937163

Your Faith/Religion

Do you identify as a Faith Leader?

Are you in any leadership position in your church?

If other, please describe

Organisational Details (Optional, if relevant)

Complete only for organisational membership (Type none if only individual membership)

Organisation Name

Name of your Organisation

Organisation Website

Your company website address

Contact Person

If you are not the organisation's official representative, or if communication should also be sent to an alternate contact person, please add details of the correct contact person

Contact Title

Contact First name

The name they are called by

Contact Middle name

Contact Last name

Last name / Surname

Contact Primary E-mail

Type "none" if they do not have an e-mail address

Organisation E-mail

Type "none" if the organisation does not have an e-mail address

Organisational Address 1

Building/Unit name

Organisational Address 2

Street name and number

Organisational Address 3

Suburb

Organisational Address 4

Province/State

Organisational Country where based

Organisational Postal Code

Organisational Telephone Number

Number where the organisation can be contacted (Include country and area code) and do not use spaces

FAITH COMMUNITIES ENDING SEXUAL AND GENDER-BASED VIOLENCE

Info: WWSOSA Members and Faith Action to End GBF Participants

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Address

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Info: WWSOSA Members and Faith Action to End GBF Participants

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