Form 0001-2004 
   

CLEAR Network
 Application Form

 
Name of Organization:
Business Address:

 

 
Telephone Nos.

Fax Nos. E-mail address: Website:
Contact Person:
Tel Nos.
  		 Cell Nos.
  		 E-mail:
  
Programs or Activities
Please enumerate your company or organization�s programs or activities concerning the preservation and conservation of the environment. Example: Solid Waste Management (use additional sheet if necessary)

Environment Conservation/ Protection Activity or Program

 

 

 

Brief Description

 

 

 

Program Duration

 

 

 

Environment Conservation/ Protection Activity or Program

 

 

 

Brief Description

 

Program Duration

 

Environment Conservation/ Protection Activity or Program

 

 

 

Brief Description

 

 

Program Duration

 

 

Environment Conservation/ Protection Activity or Program

 

 

 

Brief Description

       

 

Program Duration

 

 

Criteria:
  
-  Organization should subscribe to the CLEAR goals and objectives. 
-  Organization should be willing to share resources (e.g., speakers or manpower) and information.
-  Nature of business of Organization and/or activities/operation should not be in conflict with CLEAR objectives and goals.
-  Organization should have an existing or potential environment protection or conservation program, e.g., Waste Segregation.

   
Board of Directors and Officers
Please list down the current Board of Directors (or its equivalent) and Officers of your organization:
name position
   
   
   
   
   
   
  

Submitted by:

Authorized Signatory
(signature over printed name)

Date of submission
   
   
CLEAR Secretariat Box

Date Received: ____________________________
Date taken up by the Screening Committee: __________________________________
Action Taken :

 

Recommendation:

Control No. ___________
  
                   
  

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