www.ark.eu www.eurosite.org www.freenature.eu www.wnf.nl You can download this form from the participants' websites Nomination of sites for the Wild Europe Field Programme Yes, I have read the brochure “Wild Europe Field Programme” and I think there definitely are possibilities to develop new nature in large regions in the next twelve years. Therefore I would like to ask your attention for an area where this initiative could be implemented in the future. ARK/FREE/WWF/Eurosite will contact me if they agree it is a good potential project, to discuss my nomination further. Name: Organisation: Tel. number: Email address: For your information by separate mail (or as an attachment to this form) I will send a map of the proposed region and I have answered the next questions: Characteristics of the proposed region 1. name of the region: 2. protected areas in the region; name & size: 3. the region is (partially) a Natura 2000 site: yes / no 4. the region contains the following habitats: forest / freshwater wetlands / marine / meadows / mountains / intensive agriculture / extensive agriculture / pastures 5. I estimate the area of the region suitable for nature development to be……… ha 6. the region has or will have a lot of abandoned agricultural land for which a nature development purpose could be an interesting alternative economic option for the local communities: yes / no 7. the region is bisected by one or more major infrastructural works (e.g. super highways, high speed railways, hydropower dams): yes / no 8. there are about ……. (estimated number) people living in the area 9. local people in the region are leaving the rural areas: yes / no www.ark.eu www.eurosite.org www.freenature.eu www.wnf.nl You can download this form from the participants' websites 10. there are towns and villages in the region, namely:……… 11. the nearest city (10,000 inhabitants) is less than …... km away, namely:……… 12. in the last five years there have been serious forest fires in this region: yes/no 13. big wild herbivores or semiwild herbivores live in the region, namely:…….. 14. predators and scavengers live in the region, namely:……… 15. some herbivores, predators, scavengers or other key-species are missing, namely:………. 16. in the next 6 years there are good perspectives for (re)introduction of the following species:………….. Other characteristics 17. my organisation is a Governmental institution / international NGO / national NGO / local NGO 18. the main type of economic activity in the region is…………… 19. possibilities for own financial funds: yes/no 20. there is support for the ideas for wilderness by local people: yes/no 21. 22. there is support for the ideas for wilderness by local and regional policymakers: yes/no please name a few of the stakeholders:…………….. For your further information, I will write some explanatory notes below using no more than two pages. Thank you very much for your attention and I am looking forward to hear from you before 1 October 2009 so we can discuss the possibilities this region has to offer for the Wild Europe Field Programme! Please mail this form and map preferably before 1 August 2009 to: wilderness@freenature.eu or sent it by regular mail to: FREE Obrechtstraat 33, 6815 BN Arnhem, www.ark.eu www.eurosite.org www.freenature.eu www.wnf.nl You can download this form from the participants' websites Netherlands