Grassroots Action for the Environment - Participant Registration - 2020
Fill out the form below to let us know how you'd like to be involved in protecting the environment at the Legislature.
* Required
Name
*
Your answer
Email
*
Your answer
Phone
*
Your answer
It's ok to text me.
Yes
Clear selection
Mailing Address
Your answer
City
*
Your answer
Zip Code
*
Your answer
Who is your State Senator?
*
Click here to find your State Senator - (
https://openstates.org/find_your_legislator/
)
Your answer
Who is your State Representative?
*
Click here to find your State Rep - (
https://openstates.org/find_your_legislator/
)
Your answer
I'd like to participate in Environment Day at the Round House on January the 28th
Yes
Clear selection
What legislative areas are you most interested in?
Climate - Energy & Utilities
Climate - Oil & Gas
Water Conservation
Lands Protection
Wildlife Defense
I'd like to reserve a hotel room
We'll contact you to provide further information
Yes
Clear selection
In order to participate, I need a travel and hotel scholarship.
Availability is first come, first serve.
Yes
Clear selection
I would like to carpool and have a car I can drive.
Yes
Clear selection
I would like to carpool but need a ride.
Yes
Clear selection
List any language needs such as Spanish or ASL interpretation you have.
Your answer
List any special needs such as wheelchair access.
Your answer
Will you need childcare? If so, how many kids and what ages?
Your answer
I am willing to volunteer.
We'll assign you volunteer opportunities for the events you sign up for.
Yes
Clear selection
Are there any particular strengths, qualifications or relationships with elected officials that you bring to your grassroots advocacy?
Nothing special needed here. Being interested it absolutely enough. But if you have some special qualification that would be great. Also let us know if you have a personal relationship with a legislator.
Your answer
What organizations are you affiliated with?
List as many organizations you are a member of, active with or generally feel affiliates with.
Your answer
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