Please return this form via e-mail, fax or priority mail by the 15th September 2000 to:

CESTIM – MLAL

Via S. Michele alla Porta, 3 
37121 Verona
FAX 0039-045-8035075
E-MAIL: cestim@tin.it

European Conference

“For an European Free Phone Number against Racism”
Verona, November 20th-21st, 2000

Application Form

/_/	Our association has long been engaged in monitoring and reporting activities of racism, xenophobia, anti-Semitism and other form of discrimination as defined by art. 13 of the Amsterdam Treaty.

/_/	We agree to the creation of an European free phone number, easy to memorise, to collect accusations of racist, xenophobic anti-Semitic acts and other discriminations as defined by art. 13 of the Amsterdam Treaty.

/_/	We are interested in the Conference that will be held in Verona from the 20th to the 21st November, 2000, aimed at promoting this idea and creating a lobby to actually implement it with the co-operation of all the anti-racist groups.

/_/	We hereby ask to be formally invited to take part in the Conference.

/_/	To illustrate the contribution our organisation could give to the Conference, we attach to this form a concise report (maximum 5 sheets) concerning our experience in the field of monitoring and reporting of racial or xenophobic discrimination in the area where we operate.

Name of the organisation

Address
________________________________________________________________________

Telephone, fax and e-mail

Name, surname and telephone number of the contact
________________________________________________________________________

Date__________ 	Signature________________________________________________