ࡱ> )+(u  jbjb ] vxxxxxx,^vvrvv 0vAPPLICATION FORM 1. What is your name and city/country of residence? 2. What is your organisational affiliation(s)? 3. What is the primary focus of your or your organisation's work (e.g. human rights, women's rights, sexual and reproductive rights, lgbt, faith-based, labour, youth, etc.)? 4. We are seeking funding to enable the Dialogue to take place, as much as possible, in both English and Spanish. Please indicate whether you will be able to participate in either of these languages. If so, which do you prefer? If not, what other language(s) can you communicate in? 5. Why do you wish to participate? What do you feel you would bring to the Dialogue? What do you feel you would get out of it? 6. What international knowledge or experience do you possess (e.g. World Conferences, CHR attendance, regional conferences etc)? Please explain. 7. What regional/domestic knowledge or experience do you have (e.g. mobilising national networks, influencing governments, local activism or regional networking)? Please explain. 8. Please describe any ways in which your participation will help ensure a diverse and representative consultation (e.g. are you a member of a racialised/indigenous group, person with a disability, lesbian, gay, bisexual, transgendered, intersex person, etc)? 9. Do you have experience working on sexual orientation or gender identity issues? Please summarise. 10. There will be a registration fee of US$200/175 to help cover the costs of the Dialogue. Do you require funding assistance to attend? If so, please indicate whether you need support in paying for airfare, accommodation, a registration fee reduction or waiver and/or per diem meal allowance, and briefly explain why you or your organisation need financial support to attend. 11. Do you have any special or accessibility needs (e.g. dietary restrictions, wheelchair access, assistance with childcare etc) that you would like us to consider when planning this conference? 12. Is there any other information you would like to include? Please apply by September 30 to arc@arc-international.net For more information, contact above e-mail address or phone Kim Vance at 1-416-238-7981.  FGvw%&DEXY    w x 1 2 FGvw%&DEXY    w x 1 2  / =!"#$% [0@0NormalCJOJQJmH 2A@2Police par dfaut!    Apple/HD System G4:Desktop Folder:Arc - Liu Institute@xx`Pp&xr3g0@GTimes New Roman5Symbol3 Arial3Times"1{ < !0APPLICATION FORMAppleApple Oh+'0`   ( 4@HPX'APPLICATION FORMrdPPLAppleATpplNormalTAppleT1plMicrosoft Word 8.0d@F#@ϧ@^8gЧ<  ՜.+,D՜.+,< hp|  'IC APPLICATION FORM Titre 6> _PID_GUID'AN{0D7B3581-13BF-11D9-A95C-003065411F9E} !"#$%&'*Root Entry FG,1TableWordDocumentSummaryInformation(DocumentSummaryInformation8 CompObjXObjectPoolGG FDocument Microsoft WordNB6WWord.Document.8