Registration: Issue Campaign Workshop, May 28, Vancouver

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* 1. Please provide the following information:

Name: *

Organization: *

Address: *

City/Town: *

State/Province:

ZIP/Postal Code: *

Country: *

Email Address: *

Web Address:

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* 2. Position within Organization

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* 3. Year Organization was Founded

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* 4. Organization Mission

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* 5. Describe your organization's staff

	Number
Full Time	Full Time Number menu
Part Time	Part Time Number menu
Volunteer	Volunteer Number menu

Offer any additional comments here

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* 6. Select the option that best describes your organization's office space

Home office

Rented office space

Owned office space

Other (please specify)

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* 7. Annual Budget of your organization in USD

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* 8. Do you have donors in the following fields? If so, approximately how many?

	Number
Individual	Individual Number menu
Foundation	Foundation Number menu
Corporate	Corporate Number menu
Government	Government Number menu

Other (please specify)

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* 9. Briefly list the major programs and activities of your organization

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* 10. What is your professional background and motivation for working for a think tank?

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* 11. This highly interactive workshop will guide participants through the process of planning and implementing a campaign, participants must arrive with a specific campaign to work on. Please describe your plan below.

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* 12. On a scale of 1-5 please rank your proficiency in English

Poor

Average

Fluent speaking

Fluent speaking & written

Native tongue

To complete your registration, please submit a photo and bio (in English) to Autumn.Lansford@atlasnetwork.org no later than May 22nd.

Space is limited to 15 participants, and acknowledgement of registration will be made on a rolling basis until the program is filled.

There is no cost for attendance at this workshop. Meals will be provided on May 28th.

Please contact Cindy.Cerquitella@atlasnetwork.org with any questions or concerns.