Join us

I / we agree with the principles of the International Alliance for Health, Peace and Social Justice as set out in the Preamble to its International Programme and hereby commit to promoting the goals of the movement as a part of my/our daily activities.

I wish my/our name to be placed on the mailing list of affiliates to the movement and understand that the following details will not be used for any other purpose, nor disclosed to any other individual or organization.

First Name:

Last Name:

Position in Organization:

Organization Name:

Address:

City:

ZIP / Postal Code:

State / Province:

Country:

Email:

 

Subject:

 

Message: