MACUA & WAMUA – ADVISORY OFFICE
IEJ Offices, 3rd Floor, 62 Juta Street, Braamfontein, 2000
Telephone: +27(0) 10 007 2136 Website: www.macua.org.za email: info@macua.org.za
New Branch Application Form
1. Particulars of the person filling the form
a. Name and Surname *
b. Position in the community *
Required
c. Contact Number *
d. Email
e. Gender *
f. Age *
g. Physical Address *
2. Area / Community
a. Name of the village / township *
b. Town *
c. Municipality *
d. Province *
3. Community Background
a. Name of the Mine(s) in the area?
b. How long has the Mine(s) operated in your community?
c. What are the most pressing impacts on the community?
4. Community Structure(s)
a. Are there any community structures that engages with the Mine(s) – YES or NO, if Yes please specify
Clear selection
b. How long has the structure has been existing?
c. Does the structure report back to the community?
e. What is your relationship to these organisations?
4.1 Are there organisations in the community that deal with?
a. Mining and environmental issues? – Please list them
b. Women’s issues and rights? - Please list them
c. Youth concerns? - Please List them
5. Joining MACUA
a. Are there other community members who are interested to join MACUA?
b. If Yes, how many people would like to join MACUA
d. What is your reason for joining MACUA?
e. Are you prepared to build a MACUA branch in your area?
f. Please provide a brief motivation for starting a MACUA Branch in your area.
g. Do you have an references to your work and activism- Facebook/Twitter/News Articles- that you can share?
Submit
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