Manifesto - Sign-up Form

  • Due to the wide scope of this campaign (one million expected signatures in the first year of it's launch) the use of Internet is strongly recommended to spread the BREAKTHROUGH 2007-2012, as well as to collect the signatures.

  • If you do not have direct access to Internet, you may find it through those around you, friends, libraries, schools, universities, city halls or cybercafes.

  • This five year campaign is expected to grow in number and reach one billion people by 2012.

If you really do not have any possibility of accessing Internet, return this form after having completed and signed it.

Surname*
Name
Date of Birth
Sex:
Town of Residence
Country
Email
Date of Signup

* Your name , as a signatory of the BREAKTHROUGH 2007, will figure on the Internet site devoted to this project:
www.wmgd.net/breakthrough2007
 

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