CivicAction

First Name *

Preferred name

Last Name *

Email Address *

If you fill out this form and receive an error saying you have done so previously, please click the "Update Preferences" link in the error message.

Sector with which you most closely identify *

(This could be the sector you work or volunteer in, or are studying to join)

Organization where you identify as a rising leader *

This may be where you work, volunteer, or are affiliated with.

Title/role at that organization or group *

City or regional municipality where you work *

City or regional municipality where you live *

What is your primary reason for joining the ELN? *

Birth year *

Do you self-identify as an Indigenous person? *

Do you self-identify as a member of a racialized g *

Do you self-identify as a person with a disability *

Do you self-identify as someone in the 2SLGBTQIA+ *