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A Toxics-Free Future

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SAICM Endorsement Form

Why should your organization endorse the Common Statement?
By endorsing the Common Statement your organization is joining in this global effort to work for a future where exposure to toxic chemicals is no longer a source of harm, and to commit, along with other NGO and civil society organizations, to the SAICM goal: "to achieve the sound management of chemicals throughout their life cycle so that, by 2020, chemicals are used and produced in ways that lead to the minimization of significant adverse effects on human health and the environment."

Endorsement Process:

If your NGO endorses the NGO/CSO Global Common Statement on the Strategic Approach to International Chemicals Management, please cut and paste the form below into an email, fill it out and return it to ipen@ipen.org.
Or, download a text file in your language, see below, fill it out and then email it back to ipen@ipen.org

NOTE: Endorsements are for NGOs/CSOs and not for individual, personal endorsements.

Endorsement Form:

Download text files (.rtf) of the Endorsement Form in the following languages:

Arabic
Chinese
French
German
Portuguese
Russian
Spanish
English

NGO Common Statement and Endorsement Form:

Download Adobe Acrobat versions of the NGO Common Statement and the Endorsement Form in the following languages:

  Arabic
  Chinese
  English
  Filipino
  French
  German
  Hindi
  Bahasa Indonesia
  Italian
  Portuguese
  Russian
  Spanish
  Thai

       


Form:

Global Outreach Endorsement Form


Date:
Organization's name:


Country and headquarters address:


Contact Person:
Email address:
Website: (if any)

Geographic Area of Organization's Work
[ ] Locality, State, Province or Region of Country
[ ] National
[ ] Regional (two or more countries)
[ ] International
Name of Geographic Area :

Type of Organization (check one)
[ ] Environmental Organization
[ ] Health Advocacy Organization
[ ] Development Organization
[ ] Professional Organization
[ ] Peoples Organization
[ ] Trade Union
[ ] Consumer's Organization
[ ] Other

Possible Chemical Safety Issue Areas of Interest (check as many as apply)
[ ] Promoting improved national legislation, regulations and/or enforcement aimed at achieving the SAICM 2020 objective;
[ ] Protecting farmers, peasants, workers and/or communities from harms caused by exposure to harmful agricultural chemicals;
[ ] Protecting children, the general public and the environment from harms caused by exposure to toxic metals such as lead, mercury and cadmium;
[ ] Protecting human health and/or ecosystems from harms caused by exposure to persistent organic pollutants and other toxic chemicals of concern;
[ ] Protecting workers from occupational exposures to toxic chemicals;
[ ] Monitoring the presence of synthetic toxic chemicals in toys or other consumer products; in humans; and/or in the environment;
[ ] Promoting waste minimization and sound waste management aimed at protecting the public from harms caused by polluting facilities and practices such as open burning, waste dumping, inappropriate landfills, and polluting incinerators.

 

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