Application Form

Please fill in this short form to join the Community of Change.

For any questions, please do not hesitate to contact us at

Email *
First name *
Last name *
Company *
Where are you based? *
Your current function(s) *
Would you like to join as a partner or participant?
What motivates you to join the Community of Change? *
To what extent are you leveraging emerging technology for sustainability? *
Additional comments
A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This form was created inside of B3InX s.r.o.. Report Abuse