ACTION PROPOSAL FORM

Please submit to the USPCN registration table or submit online no later than midnight on Saturday October 30th.  You may also download the form and submit it via email to generalassembly@palestineconference.org

WHO
Please provide the information for the primary contact person as well as the names of all known participants who will be members of this action committee:

*(denotes required field)

Name: *

E-Mail Address: *

City *

Phone Number

Registration Number

Names of all known participants who are members of this action committee (please list names of all individuals)

Please identify a member of your team who can serve as liaison to USPCN Coordinating Committee *

Liaison's City

Liaison's Email

Liaison's Phone Number

Subject of Action Proposal:
Civil Rights
Political Prisoners
Sectoral Organizing (eg. youth or students or women)
Boycott Divestment and Sanctions
Community Development and/or Services
International Solidarity and Common Struggle
Community Education and Outreach
Building Diaspora Networks with other Palestinian communities
Right of Return
Jerusalem
Other

If you chose "Other," what is the subject of the Action Proposal?

Please describe your Action Proposal

Please describe the resources that you need and whether you can provide them or if these resources require USPCN national support - Resource 1:

Requires USPCN National Support:

yes no

Resource 2:

Requires USPCN National Support:

yes no

Resource 3:

Requires USPCN National Support:

yes no

Resource 4:

Requires USPCN National Support:

yes no

Resource 5:

Requires USPCN National Support:

yes no

Please list any other needed resources and if they require USPCN national support

Please describe the timeline necessary for your project. You can do this by breaking it down into a 6-12 month action plan, or alternatively a 1-5 year plan.

If you are facilitating a PMA, what are the key issues that must be including in this USPCN popular conference Closing Statement?

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