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Name of Organization: Date of Establishment Address of principal office: Telephone: Fax : E-mail: Purpose of Organization

Country code: Country code: (eg. foundation, association, non-profit corporation, CBO, network, unincorporated association) Regn No.(if any) City code: City code : Website: City Country Number: Number:

Legal Status of Organization Country/ies in which organization is active

Local Area to which organizations competence and relevance pertain: Please check one or more that applies to your organization and indicate years of experience in this sector. Focal area Biodiversity Climate Change Land Degradation Years of experience: International waters Persistent Organic Pollutants (POPs) Ozone Layer Depletion Other Years of experience:

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