Financial Assistance Form
North American Leadership Summit

For those who may be concerned about the affordability of the Summit, we are understanding of your circumstance. Please do not let this be a reason not to feel welcomed as a participant. If you would like to attend, we ask you to follow these simple steps to explain your circumstances. We cannot make guarantees that everyone will be given a scholarship, but we will do what we can to ensure that we offer a diverse representation of our community at the Summit.

Name
First Last
Email
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Bioregion
Nationality
(passport issued by)
Your PDC Date and Main Instructor (if applicable)
Describe your work and the communities where it takes place.
If asked to participate in a seminar, workshop, or panel, what areas of regeneration work would you bring to the table?
To help us solicit funds on your behalf, please write a short story about yourself for use in social media.
Please provide a photo of yourself to use in social media
Drop files here or

Max. file size: 128 MB, Max. files: 3.
Amount of support you are requesting.*
- I cannot afford the $15 basic fee and am requesting a refund.
- I cannot afford the additional fee expected of my nationality.
PINA has limited resources for the NALS at this time, so we are asking individuals attending to pay at least a small portion of their attendance fees as shown on the registration form. If you are unable to meet this threshold, please indicate.

Financial Assistance Form
North American Leadership Summit

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Financial Assistance Form North American Leadership Summit

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Financial Assistance Form
North American Leadership Summit

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