Membership Form The Belize Coalition to Save our Natural Heritage is a coalition of organizations. The goal of the Coalition is to achieve a BAN on oil exploration and drilling OFFSHORE and in ALL the PROTECTED AREAS in Belize. Join us in our mission to protect our people and their rights to safeguard our natural heritage for the benefit of all Belizeans – present and future. By becoming a member of the Belize Coalition to Save our Natural Heritage you will help us to preserve the Belize Barrier Reef, a World Heritage Site and all our protected areas from the impacts of Oil thereby safeguarding the quality of life of all Belizeans. Membership is open to All Organizations who agree with the goal of the Coalition. Individuals can also join the Coalition and become a Supporter. Please give your organization’s name if you wish to join as a Member or your individual name if you wish to join as a Supporter. Name of Organization or Individual:________________________________________________________ Type of Organization: Local NGO or Group _____
International NGO______ Private Business ______
Other(specify)_______ Name and position of Organization’s Representative:__________________________________________ Location: Village, District (if located in Belize)________________________________________________ Country (if located outside of Belize):_____________________________________________________ Phone: _________________________Email address: _________________________________________ Thank you for your interest in becoming a member or supporter of the Coalition. How would you be willing to support the Coalition? Please mark with and X to all that apply: ___ Include your Organization’s name & logo on the Coalition communication materials (please attach logo) ___Write letters to the Prime Minster and your Area Representative ___Provide technical assistant that can assist in the coalition’s efforts ___Provide financial assistance to assist in the coalition’s effort ___Provide Human resources through staff that can help in the coalition’s effort ___Conduct door to door canvassing and educating the public in your community ___Assist in fundraising activities ___Assisting with local logistics in your community to support the coalition efforts ___Other (please specify): ____________________________________________________ Should you have questions or need additional information, please contact us. Please Email,
or fax the completed form to: Belize Coalition to save our Natural Heritage Tele/Fax: (501) 223-7266 HYPERLINK "mailto:coordinator@apamo.net"
coordinator@apamo.net