Free, prior and informed consent form

This year, 2020, the International Indigenous Women’s Forum (FIMI) celebrates 20
years of being born as a global network that intertwines Indigenous Women's
organizations from Asia, Africa, Arctic, the Pacific, North, Central and South America,
and the Caribbean to develop common agendas for political and social advocacy,
capacity building and leadership of Indigenous Women in their effective participation in
decision-making processes at all levels.

FIMI is implementing a strategic and political campaign. Among the actions is the
preparation of it’s book, History of 20 years of FIMI , for which we want to know the
stories of change from our partners. For this reason, we want to meet with you for a
brief 45-60 minute interview on the positive and sustainable impacts you have had
after participating in our programs.

FIMI previously and timely specified the general principles of free, prior and informed
consent that favor me as rights for the collection and handling of my legally protected
personal data.

With this full knowledge, I authorize the audiovisual registration and the eventual publication
of my image and my voice, as well as the data that I provide and be publicly identified, for the
purposes of the FIMI 2020 Campaign and the book History of FIMI / 20 years, thus like other
of his campaigns. All this without commercial purposes.

I exempt FIMI from any responsibility for the possible handling of my information by people
that do not belong to FIMI, through any means or support.

Name _____Kamala Thapa

Date: 1st July 2020