General Registration for 2020 Virtual EJ Summit (online form)
22nd NCEJN EJ Summit Registration

We Can't Breathe: Policing, Pollution, Public Violence, and Pandemic
October 2020
For more information about the program, please visit: http://ncejn.org/
Contact ncejsummit@gmail.com with any questions.

Note: All summit activities will be held online given COVID-19. Activities will take place throughout the month of October, and will include both live (zoom) sessions and coordinated action challenges.

**Please register by September 30th if you would like to ensure receiving a mailed paper copy of the program book and/or ensure inclusion of a hosted page in the program book**
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Email *
First Name *
Last Name *
Organization *
Are you affiliated with a community group, university, nonprofit organization, governmental agency, etc.? If you have no affiliations that you would like to share with us, please put "N/A".
Mailing Address *
City *
State *
Zip *
Phone *
e.g. 999-999-9999
Fax
There is no registration fee for this year's online summit. With gratitude, we welcome donations of any amount on the NCEJN website (link: https://ncejn.org/donate/)
Checks and money orders can also be made payable to "NCEJN" and mailed to:  P.O. Box 68, Rocky Mount, NC 27802. *Note: Donating is optional.
Will you have access to reliable internet service and a computer, tablet, cell phone, or other device to participate in the virtual summit activities? *
The NCEJN may have additional resources available to assist with accessibility needs; however, members of communities impacted by EJ issues will receive priority.
If you answered "No" to the previous question, please explain any accessibility concerns regarding reliable access to internet and/or device.
The NCEJN may have additional resources available to assist with accessibility needs; however, members of communities impacted by EJ issues will receive priority.
Do you feel comfortable using Zoom? *
Zoom is the virtual conferencing application that will be used during the summit. If unfamiliar with zoom, please select "No" and you will be provided additional support and instructional resources to ensure ease of access.
Would you be willing to receive EJ Summit materials, including the program booklet, solely by email? *
Mailing of printed materials is still available for those who need or prefer hardcopy materials; however, sharing materials virtually reduces both costs and waste, and will allow for faster communications. Regardless of your response to this question, all attendees will still receive virtual materials by email.
Would you, your community, or your organization like to host a page in the EJ Summit program booklet to share Environmental Justice updates, reflections, and/or resources? *
This might include general information about your organization/community, any important updates on recent work to share with other members of NCEJN , and/or how people may become involved or provide support. All are welcome; however, priority will be given to individuals and organizations in communities impacted by EJ issues.
If you answered "Yes" to the last question and are interested in adding something to the Summit's program booklet, please provide a brief description of what you would like to have included and any other relevant information.
An EJ Summit Coordinator will follow up with those interested to collect materials and information to be included in the program.
Which of the three live sessions do you plan to attend? (please attend as many as possible!) *
We are collecting this information in order to estimate how many will be in attendance. Your response is in no way binding.
Required
How did you learn about the EJ Summit? *
(select all that apply)
Required
Are you interested in volunteering during the summit? *
EJ Summit coordinators will contact those interested in volunteering by email to confirm and assign volunteer roles. Examples of volunteer duties include note-taking, technological assistance, attendee outreach, etc.
I approve of being photographed or filmed at the 2020 EJ Summit.   *
At this time, we are planning to record the live sessions. Photos may also be taken during the live sessions. Photos and recordings may be shared on the NCEJN social media pages and/or website.
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