Membership Application

  • Membership Application

    The information you submit in this application will be kept confidential and will only be seen by (Co)Action Lab staff. The data provided in this application is encrypted and will be stored on encrypted devices. However, data safety cannot be guaranteed: by completing this form, you agree to hold yuroboros SPC and (Co)Action Lab harmless from any actions that might arise from a data breach or other exposure of the information shared in any section of this application.

  • Contact Information

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  • Preferred Secure Messaging Platform(s)*
  • Date of Birth
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  • Personal Intention

  • Practice Group(s) of Interest (select all that apply)*
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  • Social Change-Maker Experience

    The (Co)Action Lab is designed to equip members with tools, resources, and supports that are essential to make necessary, transformative changes in their communities and spheres of influence. Although social change-maker experience is not required, an aspiration to integrate social change for a more caring and compassionate world is a prerequisite for membership. This might include integrating anti-racist and anti-oppressive practices and principles to various areas of personal and interpersonal harms such as conflict, abuse, addiction, and discrimination. It could also involve ways we bring ethics, compassion, non-violence, justice, regeneration, and systems-based approaches to the wicked problems and interrelated crises that include climate, the natural environment, housing, carceral systems, infrastructure, economic participation, social inclusion, urbanization, human rights, political conflict, and war.
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  • Demographic Information

    The following questions help us ensure diversity in each Practice Group. Although demographic categories are socially constructed, they play an important role in social stratification and other systems of oppression and domination that make social transformation work necessary. If you choose not to answer an open-ended questions, please provide a reason.
  • If employed, how would you describe your primary employer (select all that apply)?*
  • If you work for an employer, how many people in your organization?*
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  • Participation and Agreement

  • Although not required, if selected to participate, would you be interested in co-facilitating gatherings for your Practice Group?*

  • I, * agree to the best of my ability to participate fully in the (Co)Action Lab Practice Group if I am accepted. If I am unable to attend a session for any reason, I will contact the (Co)Action Lab staff immediately to inform them of my situation.

    Agreed to on   Pick a Date* .
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