Winter Training 2010 Application to Register

Contact Information

First Name: *

Last Name: *

Title:

Organization:

Email: *

Address :

City: *

State: *

Zip code: *

Program

Please choose program track: *

Track A Training for Trainers in Organizational Development

Track B Warming Watersheds, Water and Energy

Payment

Payment amount: please choose one: *

I am paying for my full registration of $300

I am paying $100 now and will fill out the scholarship request below.

Payment options: please choose one:

I will pay by check. (Send payment to River Network, Attention: Dawn DiFuria 520 SW Sixth Avenue #1130, Portland, OR 07204)

I will pay by credit card by calling Dawn DiFuria at (503) 542-8393

Scholarship Request

A limited number of registration scholarships and travel scholarships are available.

Scholarship :

Please consider me for a scholarship

I do not need a scholarship to attend Winter Training

Please consider me for a registration scholarship: choose one:

$100

$200

$300

Please consdier me for a travel scholarship: choose one:

$200

$300

Registration questions

Annual budget of your group:

Number of grassroots groups you expect to train -- or communities you expect to be working with -- during the upcoming year:

State or region covered by your training programs and/or community outreach efforts:

How does your organization plan to train (or inform) organizations, communities, local officials or the public in these subjects:

What staff and financial resources do you have or plan to obtain for this effort:

For Track A participants: What types of groups do you anticipate working with in the next year? (i.e., all-volunteer citizen groups, agency-based watersehd councils, neighborhood associations, municipal governments, etc). :

For Track B participants: What kind of local, climate related campaigns are you involved in:

For Track B participants: what "success stories" can you share with other watershed leaders:

Roommate preference? Please let us know if there is someone in particular that you would like to share a room with:

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Winter Training 2010 Application to Register