PERSONAL DETAILS

    First name:

    Last name:

    Email:

    Your country:

    About you (optional):

    Characters left: 120

    Yes, please keep me posted and add my email to the campaign mailing list

    Please prove you are human by selecting the Cup.

      PERSONAL DETAILS

      First name:

      Last name:

      Email:

      Your country:

      About you (optional):

      Characters left: 120

      ORGANIZATION DETAILS

      Please only submit on behalf of an organization if you are the official contact for this campaign.

      Full name of the organization:

      Website:

      Scope of the organization (select "International" if you have chapters in a number of countries, otherwise "National"):

      Your position in the organization:

      Yes, please keep me posted and add my email to the campaign mailing list

      I confirm that I am authorized to submit this endorsement on behalf of the above organization and I give consent to the collection and use of the data entered above in accordance with the campaign's privacy policy

      Please prove you are human by selecting the Car.

        PERSONAL DETAILS

        First name:

        Last name:

        Email:

        Your country:

        About you (optional):

        Characters left: 120

        ADDITIONAL INFORMATION

        Official name of your parliament:

        Expected end of current term (year):

        Your political party:

        Twitter handle (if applicable):

        May we share a statement from you on this initiative (optional):

        Characters left: 250

        Yes, please keep me posted and add my email to the campaign mailing list

        Yes, as a current member of parliament I endorse the campaign and I agree that my name may be listed as a supporter. I give consent to the collection and use of the data entered above in accordance with the campaign's privacy policy

        Please prove you are human by selecting the Plane.