Regeneration Alliance Application
Please fill out this form to register a Regeneration Alliance with Regeneration International.
Email address *
First name: *
Your answer
Last name: *
Your answer
Physical address: *
Your answer
What geographic region will the alliance serve? (Regions may be designated by state, a known geographical region, or nation). *
Your answer
List key individuals or organizations who will help organize and lead the alliance *
Your answer
Provide a brief summary of how and why this regional alliance was/will be formed. *
Your answer
Will the alliance establish itself as a formal non-profit organization (NGO)? *
Your answer
Describe the purpose or mission of your alliance. *
Your answer
Briefly summarize the alliance's goals and how you will achieve them. *
Your answer
Would you like us to provide a customized logo for your alliance? *
Have you or will you establish a website or facebook group for the alliance? Please provide the url if you have one. *
Your answer
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: *
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Signature: *
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