World Network of Users and Survivors of Psychiatry

Organisation name :
Address :
City :
State
Postal/Zip Code :
Country :
Phone :
Fax :
Organisation email address :
Website URL :
Name of contact person :
Contact person email :
Short description of your organisation :
If you wish to remain/become a Full (i.e. voting) Member of WNUSP for your country, please fill out the extra information we require below before submitting.

Are you a national user/survivor organisation?	Yes No
Is your organisation run entirely by user/survivors?	Yes No
Are the majority of members and people in a governance role in your organisation user/survivors?	Yes No
How many members in your organisation?
How many of these members are user/survivors of psychiatry?
Please give a more detailed description of your organisation in the space below. In particular, please provide some details of your governance structure and purpose of your organisation. We may contact you for further information in order to ensure that you are eligible for Full Membership.

Notes:

The minimum information we need are those in bold
Phone and fax numbers – please include country code and any local codes – e.g. +61 3 9999 1234 is phone number 9999 12324 in Australia (61), state of Victoria (3)