National Coalition of Independent Action Transition Roadshow: North East Event 16th July 2015

1. Your details

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* 1. Please provide your contact details

Name:

Organisation (if applicable)

Email Address:

Phone Number:

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* 2. Are you an individual or a community group involved in (tick any that apply)?

Independent community action

Campaigning or advocacy

Informal political action

“Below the radar” work

Providing services as a voluntary group

Other

If other, please specify?

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* 3. Do you have any examples of activism, advocacy or action that you would particularly like to share with others at the event, if so please say a little about it?