Individuals

First Name

Last Name

Country

City

How do you identify in relation to your race/color/ethnicity?

If you have selected the option “Other,” please specify.

What is your gender identity?

If you have selected the option “Other,” please specify.

What is your background?

What do you do for a living?

What is your current occupation (activity, position or role)?

Mobile Phone

Do you accept to be included in the Colansa's Whatsapp group?

Yes, I agree No

Email Address

Do you accept to receive emails from the Colansa's membership group?

Yes, I agree No

Do you accept to receive the Colansa's newsletter (each two months)?

Yes, I agree No

Are you part of or linked to any company/institution/organization/collective/group/movement?

Yes No

If yes, which one?

How do you think you can contribute to Colansa?

How did you find out about Colansa?

Do you agree with Colansa's conceptual and political framework?

Yes, I agree No

If you answer no to the question above, please write down the reasons that you don't agree with Colansa's conceptual and political framework

Do you agree with the Colansa's Manifesto for healthy and adequate food in Latin America and the Caribbean?

Yes, I agree No

If you answer no to the question above, please write down the reasons that you don't agree with Colansa's Manifesto for healthy and adequate food in Latin America and the Caribbean

Do you have any conflict of interest to declare?

Yes No

Situations that involve conflict of interests are: activities and/or partnerships (financially funded or not) with industry, companies or organizations that are related to products, practices or politics that are not aligned to the Colansa’s conceptual and political framework, as well as to participation in activities and/or strategic decisions making. Examples from products, activities and/or services that are related to conflict of interests are: baby food producst, breastmilk substitutes and related products intended for children under 3 years of age, in accordance with current legislation; ultra-processed foods and beverages; firearms; tobacco; alcohol; pharmaceutical products; synthetic agrochemicals; genetic manipulation or patenting of seed; those that violate human rights, labour and/or fundamental rights; those involved in child labour, slave practice in any of the production stages of their products; those involved in acts of violence against men and women or any other form of discrimination and racism against any person; and those that cause disasters or environmental contamination; and food supply conglomerates.

If you answered yes to the question above, please give details about what kind of conflict of interests (such as type and the name of the industry)

be a part of colansa