Civana Founding Member Application

1

Name

First Name

Last Name

2

E-mail

3

Phone Number

Country Code

Area Code

Phone Number

4

Country of Primary Residence

Country

6

Primary Area of Contribution InterestPlease select all areas where you possess skills, knowledge and interest in contributing.

Community Organizing / Advisory

Collaboration Practice Development

Fundraising

Communications & Movement Building

Partnerships

Platform Development

AI/Machine Learning

7

Anything you would like to share about your interest?

8

Suggest other possible founding membersPlease provide the name and email addresses of anyone you would like us to reach out to as a possible founding member.