ERROR: Please indicate Mr. Mrs. or Mrs.
 ERROR: Please indicate your first name.
 ERROR: Please indicate your last name.
 ERROR: Please indicate your country.
 ERROR: Please indicate your street address.
 ERROR: Please indicate your city.
 ERROR: Please indicate your office telephone number.
 Name: #form.MrMs# #form.firstname# #form.lastname# Work Address: #form.mail1# #form.mail2# #form.ciudad# #form.provincia# #form.Country# #form.codpos# Phone: #form.phone1# fax: #form.fax# Email: #form.email1# Home Address: #form.homemail1# #form.homemail2# #form.homecity# #form.homeprovincia# #form.homeCountry# #form.homecodpos# Phone: #form.phone2# Fax: #form.homefax# Email: #form.email2# Preferred language: #form.idioma# Contact by: #form.contactemail# - #form.contactmail# - #form.contactfax# - #form.contactphone# Expertise: #ParagraphFormat(FORM.expertise)# Willing to share expertise: #form.contactexpertise# Parliament that represents: #ParagraphFormat(FORM.parliament)# Terms-Years: #ParagraphFormat(FORM.terms)# Committees: #ParagraphFormat(FORM.committees)# Anti-Corruption Experience: #ParagraphFormat(FORM.anticorruption)#

Membership Form
- PDF File     - Word File

Personal Information
Mr. checked> Mrs. checked> Ms. checked>
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: checked> Fax: checked> Mail: checked> Telephone: checked>

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