NJEJA Organizational Membership Application

Contact Info of Person Representing Organization

First Name *

Last Name *

Title or Position at Organization

Pronouns

Email *

Phone Number *

Organization Info

Organization Name *

Mailing Address *

City *

State *

Zip Code *

Email *

Phone Number

Organization's Website (please enter as http:// or https://) *

Organization's Facebook handle (please enter as https://facebook.com/org-handle-name)

Organization's Twitter handle (please enter as https://twitter.com/org-handle-name)

Organization's Instagram handle (please enter as https://instagram.com/org-handle-name)

Is your organization located in or does it serve an environmental justice or overburdened community? *

Yes

If so, which one(s)?

Which environmental justice and/or climate justice issues are most important for your organization? *