4th Annual NMCEWL Summit
2021 Registration Form
Name:
*
First Name
Last Name
Email:
*
example@example.com
Phone Number:
Please enter a valid phone number.
Organization / Operation / Agency:
*
Title / Role:
Please briefly describe your work as it relates to working lands in New Mexico.
*
Have you participated in an NMCEWL Summit in the past?
*
Yes
No
What is something you would like to get out of the Summit this year?
*
Are there specific topics you are interested in discussing or learning about in the Summit?
*
What is a collaboration you were a part of in the last year that has excited you or that has benefitted your work?
*
What is a project or idea you are working on that you might want others to collaborate on?
*
Do you have any special accommodations or concerns regarding use of Zoom? If so, please specify so we can be in touch to assist you.
Would you like to receive a New Mexico grown snack box?
*
Yes
No
If yes, please provide the mailing address where you would like the snack box sent. Otherwise, you can leave the below information blank.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I most strongly identify myself or my organization as:
Academic (Student)
Academic (Researcher/Instructor)
Business/Corporation
Environmental/Conservation Organization
Farmer
Healthcare or Community Health Organization
Government Agency
Media
Non-Profit/Foundation
Public
Rancher
Tribal
Other
What gender do you most identify with?
What ethnicity do you most identify with?
Submit
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