Registration Form: WWSOSA AGM

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Thank you for taking the time to register for this meeting and for completing this registration form!

Where a question asks you to select an option, please do not add your own answer, but leave that for questions requesting your further input. Please answer ALL QUESTIONS, or you will not be able to submit your form.

NOTE: POPI Act - Your personal information will only be used for the purposes of this registration, or if you agree to join as a member or be added to the Distribution List, for purposes of direct communication within We Will Speak Out SA and the Faith Action Collective only and will not be shared with any outside body. (See the final Question below.)

Email *

1. Your Title of address *

2. First Name *

3. Surname *

4. Phone Number *

5. Organisation (Name) or Individual *

6. What gender do you identify as? ( you may select more than one)

7. What is your age group?

8. Are you a member of the We Will Speak Out South Africa Coalition? (If you tick the 3rd or 4th option below, here is the link to the online membership form: https://www.wwsosa.org.za/wwsosa-membership/online-membership-form/ *

Yes

No, I am just visiting

I would like to become a member

I am not sure if I am a member or not

No, but I am a subscriber

9. Please indicate your faith organisation or affiliation *

10. Please indicate your organisation type *

11. Main Province/s where you operate (if all, select National) *

Eastern Cape

Free State

Gauteng

KwaZulu-Natal

Limpopo

Mpumalanga

North West

Northern Cape

Western Cape

National Organisation

International Organisation

Required

12. Would you like to be on the general WWSOSA or Faith Action to End GBV Collective News Distribution list? *

Yes - Please add me to the WWSOSA mailing list

Yes- Please add me to the Faith Action email or Whatsapp group

I would like to unsubscribe so I no longer receive communications

I would like to receive all information

I am already on the WWSOSA mailing list

I am already on the Faith Action to End GBV Collective mailing list

Other:

13. Have you heard of the National Strategic Plan on Gender-Based Violence and Femicide (NSP)? *

Yes

Not yet but I would like to learn more

I am not sure

Other:

14. Would you like your organisation to be part of a database for our internal use, to refer members to each other for capacity support or mutual learning *

Yes, and we can share more information about what we do

Not at the moment, thanks

We do not have any GBV activities at the moment

I would have to speak to my leadership before answering this question

15. Permission

Please indicate if your organization is happy for the above information to be used in the following ways :

Yes, for use internally just to circulate communications

Yes, for use internally but also to add to a broad database of Faith Actors involved in GBV work (personal information will not be shared)

A copy of your responses will be emailed to the address you provided.

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