Registration Form

Hello and thank you for registering for the Southeast Convergence for Climate Action. Due to food and program planning we really appreciate your preregistration. The groups organizing the Convergence have put a tremendous amount of resources into putting it on. We are asking for a $50-100 donation for attending the full week. Nobody will be turned away for lack of money, though we ask that you please attempt to raise the funds and contribute to the Convergence.

Click here for directions.

Required items are denoted with an "*".

Name *
Address *
Phone *
Email *
Age *

Dates you are planning to attend: *

What groups do you work with?

Do you have any workshops you would like to offer?

How did you hear about the Convergence?

Amount donating to the Convergence (we're asking $50-$100 for the week): *
$

I'm requesting to attend the convergence for free

Would you like to request travel assistance funds. If so please explain your situation. Please note that these are extremely limited.

Do you have any special needs?

We want the Convergence to be a family friendly space and will be providing childcare to the best of our abilities. If you are planning on utilizing it, how many kids are you bringing?

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