9th Extreme Energy Extraction Summit Application
Thanks for your interest in attending the next E3C Summit to be held May 30th-June 3rd at Colby Ranch in Palmdale, CA. Applications are DUE Monday April 1st. 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
What are the current top three priorities of your organization at this moment? (this could be particular campaigns or other focus areas such as base-building or internal re-structuring) *
Your answer
What region/communities does your organization serve and/or represent? Who are you accountable to? *
Your answer
What is your organization's annual budget? (If it's complicated, explain in "other") *
Please describe your personal and movement background. We strive for our Summits to be as diverse as possible, both in terms of “demographics” (age, gender, race, class, etc) and in type of work people do (community organizing, policy, direct action, technical support, etc). *
Your answer
How did you find out about the Summit? *
Your answer
Why do you want to attend the Summit? *
Your answer
Is there anything we should know?
Your answer
The first day of our Summit will be an Environmental Justice Tour of LA. Will you be able to arrive by Thursday night (30th) to attend the tour? (We will be staying in a separate hotel and need to know how many rooms to book). *
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 3rd?
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
Most of the housing at Colby Ranch is in small cabins with 10-14 bunk beds. There is a very limited supply of more private rooms. Please let us know your housing needs below. (If you are ok in a cabin, don't check anything).
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service