JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Grassroots Action for the Environment - Participant Registration - 2019
Friends, we're asking for a lot of information from you below. Please know that you don't have participate in all of these activities. We don't want to overwhelm you. You are welcome to click every box, but you don't have to.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name
*
Your answer
Email
*
Your answer
Phone
*
Your answer
It's ok to text me.
Yes
Clear selection
Mailing Address
Your answer
City
*
Your answer
Zip Code
*
Your answer
Who is your State Senator?
*
Click here to find your State Senator - (
https://openstates.org/find_your_legislator/
)
Your answer
Who is your State Representative?
*
Click here to find your State Rep - (
https://openstates.org/find_your_legislator/
)
Your answer
I will commit to contacting my legislator through e-mail, phone call, or letter to introduce myself and our issues ,
We will provide you with template letters.
Yes
Clear selection
I will commit to joining a team visiting the state legislators in my city before and after the legislative session.
We will supply you with talking points about the issues.
Yes
Clear selection
I will commit to serving as grassroots team delegate from my city to travel to the Roundhouse during the session.
Travel scholarships are available.
Yes
Clear selection
I'd like to participate in Lands, Water and Wildlife Lobby Day
Wednesday, February 13th, 8am - 3:30pm, New Mexico State Legislature (no fee)
Yes
Clear selection
I'd like to participate in Bring it Home for the Environment Lobby Day
Week of March 5th, Details TBA, New Mexico State Legislature (no fee)
Yes
Clear selection
What legislative areas are you most interested in?
Climate - Energy & Utilities
Climate - Oil & Gas
Water Conservation
Lands Protection
Wildlife Defense
I'd like to reserve a hotel room where we have a block held.
Rooms are $68.11 per night at Garrett's Desert Inn (includes taxes). Availability is limited.
Yes
Clear selection
In order to participate, I need a travel and hotel scholarship.
Availability is first come, first serve.
Yes
Clear selection
I would like to carpool and have a car I can drive.
Yes
Clear selection
I would like to carpool but need a ride.
Yes
Clear selection
List any dietary restrictions you have.
Your answer
List any language needs such as Spanish or ASL interpretation you have.
Your answer
List any special needs such as wheelchair access.
Your answer
Will you need childcare? If so, how many kids and what ages?
Your answer
I am willing to volunteer.
Click here for more information -
https://goo.gl/forms/PyF9mMVlyp1HHcam2
. We'll assign you volunteer opportunities for the events you sign up for.
Yes
Clear selection
Are there any particular strengths, qualifications or elected officials that you bring to your grassroots advocacy?
Nothing special needed here. Being interested it absolutely enough. But if you have some special qualification that would be great. Also let us know if you have a personal relationship with a legislator.
Your answer
What organizations are you affiliated with?
Click on as many organizations you are a member of, active with or generally feel affiliates with.
Adelante Progressive Caucus
Amigos Bravos
Climate Defenders New Mexico
Conservation Voters of New Mexico (CVNM)
Environmental Justice Team of Unitarian Universalist Church of Santa Fe
Environment New Mexico
Environmental Defense Fund (EDF)
Frack Free Four Corners
Gila Conservation Coalition
Gila Resources Information Project (GRIP)
Indivisible Nob Hill
New Energy Economy (NEE)
New Mexico Interfaith Power and Light (NMIPL)
New Mexico Solar Energy Association (NMSEA)
Multicultural Alliance for a Safe Environment (MAE)
New Mexico Wild
Union of Concerned Scientists (USC)
Sierra Club
WildEarth Guardians
Western Environmental Law Center (WELC)
350 New Mexico
I would like to make a donation to support scholarships for this event.
Click here to make your donation to the scholarship fund -
https://bit.ly/2Ee6W8t
Yes
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
Forms
This form was created inside of Sierra Club.
Report Abuse
Terms of Service
Privacy Policy