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Form for individual support and possible partnership

After registration into the Network ///// click here //////
whether you are also willing to be a member of the NGO and pay the membeship fee

* These items will be included in the list of the Network members on the website
authorizaion by CNIL n 101 07 50

Sexe* =   Ms or Mr

Last Name/ Appelido/Nom* :
First Name/Nombre/Prnom* :

Title : University Grade :

Discipline Speciality* : The Group you join :
(official for teaching / research /writing or let in blank)

° Speciality is to mention when you are in group P
Group P: you are a (P)rofessional involved in producing/disseminating knowledge
Group E : you are an actor trying to (E)xperiment new ways
in the working of economic activities (eg in solidarity economy)
Group C : you are willing to actively participate as a (C)itizen to the debate supporting
these experiences and the attempt of building and sharing new knowledge on economic activities.

Position : Position Other :

Institution (category) :

My Institution is willing to make a partnership with PEKEA (Group CA)
YES or NO :
Group CA: your organization wish to have a partnership with PEKEA

Full Address to receive mail by post:
Including when appropriate name of institution, ZIP Code, and Country
Category of Address :

Tel N : Fax N :

E-mail address : *compulsory- obligatoire- obligatorio

Additionnal e -mail address
Or/and Home page internet url :

City* : Country* : Preferred Language :

* "City" and "Country" as they will appear in the list of Network members on the website

Last modified
25-02-2006 17:Feb