Regeneration Alliance Application

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Please fill out this form to register a Regeneration Alliance with Regeneration International.

Email *

First name: *

Last name: *

Physical address: *

What geographic region will the alliance serve? (Regions may be designated by state, a known geographical region, or nation). *

List key individuals or organizations who will help organize and lead the alliance *

Provide a brief summary of how and why this regional alliance was/will be formed. *

Will the alliance establish itself as a formal non-profit organization (NGO)? *

Describe the purpose or mission of your alliance. *

Briefly summarize the alliance's goals and how you will achieve them. *

Would you like us to provide a customized logo for your alliance? *

Yes

Have you or will you establish a website or facebook group for the alliance? Please provide the url if you have one. *

By submitting this application I acknowledge the following:

The applicant alliance will be self-organized and self-funded.
The RI Steering Committee reserves the right to revoke affiliation with Alliances that fail to uphold RI’s mission.
Regeneration International is not legally or financially responsible for the statements or actions of the applicant alliance.

Date: *

YYYY

Signature: *

Submit

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