Earth Rights Institute - Niger Delta Fund Initiative: Partnership Application Form

Letter of Introduction
Executive Summary
Phase I Budget
Partnership Application Form
Endorsing Organizations
Additional Information

Niger Delta Fund Initiative - Partnership Application Form

Thank you for your active support of the Niger Delta Fund Initiative. Please copy the below information into an email, or print and mail it. Postal and email addresses are at the bottom of this page.
Name:
Organization:
Organizational Role:
Street Address / Box #:
City:
State/Province:
Postal Code:
Country:
Phone:
Fax:
Email:
Website:

Please indicate your Partnership Commitments:
Yes / No - Include me on the NDFI e-list to receive approximately two updates per month.
Yes / No - You may list me as an endorser of the Initiative.
Yes / No - You may list my organization as an endorser of the Initiative.
I / my organization is willing to partner with the NDFI in these capacities:

I / my organization hereby volunteers these services:

I / my organization will give (select one below) or more and be listed as a co-sponsor.
N60,000 / $500 / # 400 / Euros 600
I / my organization will give (select one below) or more and be listed as a contributor.
N18,000 / $150 / # 100 / Euros 180
I my organization will give (select one below) and be listed as a supporter.
N1,200 - N12,000 / $10 - $100 / #10 - #100 / Euros 20 - 150

Financial contributions WITHIN Nigeria should be sent to:
Gordon Abiama, Director, Africa Center for Geoclassical Economics, Bosy Plaza, Km 1 Tombia Road, Etegwe, Yenagoa, Bayelsa State or P.O. Box 50124, Falomo, Ikoyi, Lagos.
Tel: 08023171096
Email: gordon@earthrights.net
CHECKS SHOULD BE MADE PAYABLE to: Niger Delta Fund Initiative
Financial contributions OUTSIDE Nigeria should be sent to:
Alanna Hartzok, Earth Rights Institute, Box 328, Scotland PA 17254, USA
Tel: 717-264-0957
Email: alanna@earthrights.net.
CHECKS SHOULD BE MADE PAYABLE to: Earth Rights Institute (contributions are tax deductible)
If you send this form by email, please email to both of us your intent to contribute financially and when and how we should expect to receive your contribution. We are maintaining clear, audited and transparent financial records available at your request. Thank you very much.

NEXT: Endorsing Organizations

http://www.earthrights.net/nigeria/appform.html