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.

Name:

Organization:

Organizational Role:

Street Address / Box #:

City:

State/Province:

Postal Code:

Country:

Phone:

Fax:

Email:

Website:

Please check the boxes below to indicate your Partnership Commitments:
Include me on the NDFI e-list to receive approximately two updates per month.
You may list me as an endorser of the Initiative.
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. CHECKS SHOULD BE MADE PAYABLE to: Niger Delta Fund Initiative. Tel: 08023171096 Email: gordon@earthrights.net
All checks outside Nigeria should be made payable to: Earth Rights Institute, Box 328, Scotland, PA 17254 USA (Tax deductible.) Tel: 717-264-0957 Email: alanna@earthrights.net.
If you receive 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.
Gordon Abiama gordon@earthrights.net
Alanna Hartzok alanna@earthrights.net

NEXT: Endorsing Organizations

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