Bridging Movements to Build Climate Justice: Participant Info

Thank you for taking the time to share this information with the Bridging Movements to Build Climate Justice conveners!

The form will be used to compile biographies, make sure there's food you're able to eat, book your travel, and answer Pocantico Center questions about our participants. Any questions can be directed to PopDev Assistant Director Katie McKay Bryson at popdev@hampshire.edu or (413) 559 5506.

First Name: *

Last Name: *

Organization: *

Mailing Address: *

Preferred Phone Number: *

Gender: *

The Pocantico Center requires this information. Please contact Katie at popdev@hampshire.edu with any questions.

Race & Ethnicity:

The Pocantico Center requests this information if you would like to provide it.

Accessibility Needs:

Do you have any mobility or accessibility needs you would like the Pocantico Center to be aware of?

Food Needs:

Do you have any dietary restrictions or preferences you would like the Pocantico Center to be aware of?

Personal Bio: *

Please give us a brief, 3-5 sentence biography to share with other convening participants:

My organization will cover my travel: : *

I prefer:

I will arrange my travel and request reimbursement: : *

I prefer:

I would prefer that the convening purchase my ticket:: *

I prefer: