Impacted Community Scholarship Registration for 2020 Virtual EJ Summit  (online form)
21st NCEJN Virtual EJ Summit Registration (IMPACTED COMMUNITY SCHOLARSHIP -- Community members affected by environmental injustices). All activities will be held online or mailed given COVID-19.

We Can't Breathe: Policing, Pollution, Public Violence, and Pandemic
October 2020
http://ncejn.org/
Contact ncejsummit@gmail.com with questions.
Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name *
Please share with us the impacted community you are from. *
Affiliation *
Are you affiliated with a community group? If you have no affiliations that you would like to share with us, please put "N/A".
Email Address *
Please provide a working email address so we may verify your registration with you.
Mailing Address *
City *
State *
Zip *
Phone *
e.g. 999-999-9999
Fax
Impacted Community Scholarship Registration Type *
Would you like to make a donation?
There are many ways you can do so: PayPal/ credit card (Go to https://tinyurl.com/NCEJN-money), Check (Mail to: P.O. Box 68, Rocky Mount, NC 27802), Money Order (Mail to: Box 68, Rocky Mount, NC 27802), or On-site cash. You may make the check or money order to NCEJN.
Clear selection
Would you like to nominate someone to receive an NCEJN Award?
Steve Wing International EJ Award, NCEJN Community Resilience Award, EJ Youth Vanguard Award
Clear selection
How did you learn about the EJ Summit?
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms