4th Annual NMCEWL Summit
2021 Registration Form
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?
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?
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 Line 2
State / Province
Postal / Zip Code
I most strongly identify myself or my organization as:
Healthcare or Community Health Organization
What gender do you most identify with?
What ethnicity do you most identify with?
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm