(Each participating student or child, his or her parent or legal guardian or a sponsoring teacher or organization must sign this form.)
By signing this form, I certify that this poster is my original work and give permission to the UNPFII to display my work, my name. I acknowledge
that submitted materials become the property of United Nations and cannot be returned.
(Please type or print clearly.)
Student Name ___________________________ Date ________________________
Age ___________________________ Gender ______________________
Student Signature ________________________ Grade _______________________
Signature of Parent or Legal Guardian _____________________________
Name and Signature of Sponsoring Teacher or Organization _____________________________
School or Organization Name _____________________________
School or Organization email _____________________________
School or Organization Address _____________________________
City/State/Zip _____________________________
Please send artwork and completed form to:
Secretariat of the Permanent Forum for Indigenous Issues
United Nations Headquarters, 2 UN Plaza
Room DC2-1772
New York, NY 10017
Tel: (1) 917-367-5100
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