7th Extreme Energy Extraction Summit Application
Thanks for your interest in attending the next E3C Summit to be held March 10th-13th at the Christian Renewal Center in Dickinson, TX just outside of Houston. Applications are DUE Friday December 30th. While we accept as many talented organizers and activists as possible, we have limited space and strive for maximum diversity of representation. Please contact us at www.stopeextremeenergy.org/contact_us if you have any questions.
First Name *
Your answer
Last Name *
Your answer
Title
Your answer
Organization *
Your answer
Email *
Your answer
Phone *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Please give us a brief bio and summary of your organization's work (250 words) *
Your answer
The first day of our Summit will be an Environmental Justice Tour of communities in the Houston area. Will you be able to arrive by Thursday night (9th) to attend the tour? *
We heavily encourage participants to stay for the entire Summit. However, we understand that isn't always possible. Will you have to leave before lunch on Monday the 13th?
E3C has always operated on a sliding scale ensuring cost is not a barrier to participation, but we have very limited funding. The full cost per participant of the Summit is $400. Registration fees help us fund travel for those who can't afford it. Please indicate what you will be able to contribute. *
We are committed to provide travel scholarships to all participants that need them. Please look into the cost of your travel and give us a realistic estimate of how much support you will need.
Your answer
Dietary Restrictions
All rooms at the Christian Renewal Center are double occupancy (2 per room). Please let us know if you have a roommate preference or special needs that require a private room.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms