JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
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
Sign in to Google
to save your progress.
Learn more
* Indicates required question
New Branch Application Form
1.
Particulars of the person filling the form
a. Name and Surname
*
Your answer
b. Position in the community
*
Concerned member of the community
Leader of a local CBO "Community Based Organisation"
Traditional Leader
Member of Traditional Council
Other, Please specify
Required
c. Contact Number
*
Your answer
d. Email
Your answer
e. Gender
*
Your answer
f. Age
*
Your answer
g. Physical Address
*
Your answer
2.
Area / Community
a. Name of the village / township
*
Your answer
b. Town
*
Your answer
c. Municipality
*
Your answer
d. Province
*
Your answer
3.
Community Background
a. Name of the Mine(s) in the area?
Your answer
b. How long has the Mine(s) operated in your community?
Your answer
c. What are the most pressing impacts on the community?
Your answer
4. Community Structure(s)
a. Are there any community structures that engages with the Mine(s) – YES or NO, if Yes please specify
Yes
No
Other:
Clear selection
b. How long has the structure has been existing?
Your answer
c. Does the structure report back to the community?
Your answer
e. What is your relationship to these organisations?
Your answer
4.1 Are there organisations in the community that deal with?
a. Mining and environmental issues? – Please list them
Your answer
b. Women’s issues and rights? - Please list them
Your answer
c. Youth concerns? - Please List them
Your answer
5. Joining MACUA
a. Are there other community members who are interested to join MACUA?
Your answer
b. If Yes, how many people would like to join MACUA
Your answer
d. What is your reason for joining MACUA?
Your answer
e. Are you prepared to build a MACUA branch in your area?
Your answer
f. Please provide a brief motivation for starting a MACUA Branch in your area.
Your answer
g. Do you have an references to your work and activism- Facebook/Twitter/News Articles- that you can share?
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
