WOW Stakeholder Participation

COLLABORATOR's PARTICIPATION FORM

This application serves to apprise WOW Bali of your organization's basic information and how we can maximize our partnership for optimum sustainable regenerative development.
Please check

IndividualOrganization
Name
Title
Name of Organization/ Company
Head of Organization/ Company

First NameLast Name
Are you the designated focal contact person?

YesNo
If No, please indicate the name of the focal contact person for your organization/ company.

First NameLast Name
Phone Number of Focal Contact Person

Area CodePhone Number
E-mail Address of Focal Contact Person
NATURE OF ORGANIZATION
Stakeholder's Positioning:
Please describe the areas of mutualism support and development. List the resource commitments that you and/or your organization are offering that will align with our Smart Center collaborations.
Please let us know of the current project you are working on and how it may have an affect and/or be effective for WOW efforts and/or Smart Center collaborations.
What considerations through resource sharing and creative economics do you see between our efforts to be successful? (i.e. creative talent, information, relationships exchanges)
What exchange considerations and/or expectations do you expect from our Smart Center collaborations? (i.e. monetary based and/or material considerations)
PARTNERSHIP/COLLABORATION DYNAMICS
Have you experienced and/or well informed of our Human Biodiversity Framework?

YesNo
If YES, where was your experience and what did you take away from the experience and/or learning exchange?
If NO, would you like to schedule a WOW Experience and/or get more information about our framework?
What areas of Human Biodiversity Framework are you interested in? (Feel free to choose more than one preference.)
Preference 1
Preference 2
Preference 3
Please give us a brief description of your interests and/or how you see our collaborations fostering the above preferences.
Would you like to participate in one of the following “Smart Center”?

Majayjay Smart Center (Laguna, Philippines)Cultural Wealth Project (Bali, Indonesia)Kerta Smart Center (Bali, Indonesia)Bindu Smart Center (Bali, Indonesia)
ORGANIZATIONAL and COMMUNICATIONS INFORMATION
Organization/ Personal Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail*
Website
If You have your own www.com
Social Media
List down your preferred social media sites.
Best time and methods of contact
(Example: Weekends and night time 6-9PM; please use Social Media and/or email)
SYMBOLS OF THE UNIVERSE ANALYSIS

Please indicate the number of importance based on your connections with the five (5) symbols above, 1 being your most favorite and 5 your least favorite.

	Square	Triangle	Spiral	Circle	Cross
Rank

Please share your analysis from my Shape of the Universe via my contact.

YesNo
This stakeholder's application was unanimously adopted by the designated WOW Bali stakeholder for collaborations with our "Smart Centers." The submission of information above represents the full commitment of the collaborators and/or their organization to participate actively in the collaboration and implement fully all elements submitted in this application.
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COLLABORATOR's PARTICIPATION FORM