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Membership Form
- PDF File     - Word File

Personal Information
Mr. Mrs. Ms.
Name:
Lastname:
Work Address:
Home Address:


City:      
Province:
Postal Code:

Country:


City:      
Province:
Postal Code:

Country:
Work E-mail:
Home E-mail:
Work Telephone:
Home Telephone:
Mobile:
Work Fax :
Home Fax:
Preferred Language:
How do you prefer to be contacted:
Email: Fax: Mail: Telephone:

Professional Background
 
Professional Expertise:

 Are you willing to be contacted to share your expertise?
 
Specify which parliament you represent and if you are from the upper or lower house (if applicable):
Terms/Years as Member of Parliament:
Parliamentary Committees Served in:
Previous anti-corruption involvement and experience:

 

GOPAC Secretariat

255 Albert Street, Suite 802
Ottawa, Ontario CANADA
K1P 6A9


Tel: (613) 237-0143 x. 319
Fax: (613) 235-8237


secretariat@gopacnetwork.org

www.gopacnetwork.org

 

 
Global Organization of Parliamentarians Against Corruption - GOPAC
C/O Parliamentary Centre
255 Albert Street Suite 802 Ottawa, Ontario K1P 6A9 Canada
Tel: 613.237.0143 Ext. 319 Fax: 613.235.8237
info@gopacnetwork.org