Global Network of Religions for Children

Thank you for your interest in the 1ST Regional Faith Leaders Forum on FORB, “Faith In Action: Mobilizing Communities Towards Social Cohesion and FORB”.

Faith In Action is organised by Arigatou International—Nairobi (AI-N) and the Norwegian Church Aid (NCA), in collaboration with RPP Nested partners.

Kindly complete this registration form and send to Nyambura Gichuki (n.gichuki@arigatouinternational.org) and Gerald Acho (ecpprograms@arigatouinternational.org), by Friday, 10th July 2020.

Send your scanned passport information page, together with your completed registration form.

Join the conversation on Twitter , Facebook and Instagram #ILeadPeace #FaithInAction

^* Required fields

ABOUT YOU

INDIVIDUAL INFORMATION

Full Name (as it appears on your passport/National ID): *Kindly also scan and send a copy of your passport information page^*

Surname / Last Name:^*

First Name:^*

Other Name(s):^*

Nationality:^*

Gender ( Female / Male):^*

Date of Birth ( Day/ Month/ Year) ^*

Religious Faith (Please Specify):^*

TRAVEL AND ACCOMMODATION INFORMATION

Passport Number: (Participants from Kenya can indicate their National ID Number):^*

Date of Passport Issue:^*

Date of Passport Expiry: ^*

Country and City of Departure: (for travel purposes)^*

Country and City of Return: (for travel purposes)^*

Do you require an entry visa to travel to Kenya (Yes/ No)^*

What is the estimated visa fee? (amount in US Dollars)^*

Special Requirements ( Please specify : e.g. Accessibility assistance, food)^*

PERSONAL CONTACT INFORMATION

Primary E-mail:^*

Alternative E-mail (if available):

Primary Mobile / Tel:^*

Alternative Primary Mobile / Tel (if available):

Other Contact Information (e.g. WhatsApp / Viber/ Twitter / Instagram) (optional):

EMERGENCY CONTACT INFORMATION

Emergency Contact Person: (Please write the name in full):^*

Primary E-mail:^*

Alternative E-mail (if available):^*

Primary Mobile / Tel:^*

Alternative Primary Mobile / Tel (if available):

Specify their relation to you: (e.g. Parent/ Brother/ Sister/ Parent/ Guardian/ Teacher):^*

ABOUT YOUR ORGANISATION / TEAM / GROUP

Name of Organization (Please write the name in full):^*

Location (Country and District/City/Town):^*

Name of Contact Person (First Name, Last Name):^*

E-mail of Contact Person:^*

Organisation E-mail (if available):

Organisation Website (if available):

Organisation Facebook Page (if available):

Organisation Twitter Handle (if available):

Do you have reliable internet connectivity? Yes/No^*

Do you have experience using zoom? Yes/No

ABOUT YOUR FAITH IN ACTION PROJECT

2) What are your main expectations of the Regional Faith Leaders Forum? ^*

3). Would you be willing to commit yourself for the next four years in this program? (Yes/No)^*

Remember: Kindly send your completed form and passport information page to n.gichuki@arigatouinternational.org and ecpprograms@arigatouinternational.org by 10th July 2020.

For any concerns or clarification, please contact the relevant person:

Overall Faith In Action information:
Nyambura Gichuki: n.gichuki@arigatouinternational.org . Mobile/ WhatsApp + 254 720 148 701
Gerald Acho: ecpprograms@arigatouinternational.org. Mobile/ WhatsApp +254 701 066 117

General Inquiries:
Florence Omtokoh: f.omtokoh@arigatouinternational.org. Office Mobile + 254 705 320 970

We also welcome you to connect with us through:

Website: endingchildpoverty.org
Facebook: End Child Poverty
Twitter: @IIECP
Instagram: endchildpoverty_arigatou
Secretariat E-mail: nairobi@arigatouinternational.org

Hashtags: #ILeadPeace #FaithInAction

RFLF Registration Form