Membership |

Full Name:

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Age:

Gender:

Academic attainment

Governorate:

Phone Number:

Enter a valid phone number. Use international format starting with +, such as +963912345678, +963 912 345 678, or +12025550123. Use no more than 128 characters.

Email:

Are you applying as:

Other capacity:

Do you have connections with groups of persons with disabilities or their families?

Yes

Please describe the nature of the work of these groups:

Describe the nature of the work of these groups. Use no more than 255 characters.

Working Area / Specialization:

Describe your working area or specialization. Use between 5 and 255 characters.

Support Areas:

Participation in media campaigns

Providing services/resources (such as translation, training, and logistical support)

Financial support or project funding

Legal or technical consulting

Policy development and recommendations

Advocacy and mobilization

Media networking

Relations with officials

Other

Other support:

Describe the additional support area. Use no more than 255 characters.

I agree to the use of my data to contact me regarding activities of the Disability Rights Movement. I understand that this data will be used for organizational purposes only.

Membership

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