Climate Justice Alliance Member Application Form

Contact 1

Membership Application Form

First Name of person completing this application

Last Name of person completing this application

Name of Organization

Organizational Information (description):

Street Address

City

State

- Select -AlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasArmed Forces AmericasArmed Forces EuropeArmed Forces PacificBritish ColumbiaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundland and LabradorNorth CarolinaNorth DakotaNorthern Mariana IslandsNorthwest TerritoriesNova ScotiaNunavutOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUnited States Minor Outlying IslandsUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingYukon Territory

Zip Code

Email

Phone Number

Twitter Handle (please enter as https://twitter.com/yourhandle)

Website (Main)

Website (other)

Primary Contact Information:

Primary Contact Name

Primary Contact Email

Primary Contact Phone

Alternate Contact Information:

Alternate Contact Name

Alternate Contact Email

Alternate Contact Phone

Please share the name of person/organization that recommended you apply

Organization's Mission

My organization falls under the following category(ies):

Base building frontline organization

Union or Worker Center

Regional / National network or alliance

Movement support Organization

Other

If Other, Please Specify:

Please list 3 main issues that your organization works on:

Which of these Just Transition sectoral shifts does your organization work on (Check all that apply):

Energy Democracy (Clean Community Energy)

Food Sovereignty, Water, and Land

Zero Waste

Public Transportation

Efficient, Affordable, and Durable Housing

Ecosystem Restoration and Stewardship

Briefly describe the methods and strategies of your work:

Who are your main constituency or partners (if applicable):

Where is your geographic focus (sample regions based on Bureau of Economic Analysis):

New England (CT, ME, MA, NH, RI, VT)

Northeast/Mid-Atlantic: (DE, DC, MD, NJ, NY, PA)

Great Lakes (IL, IN, MI, OH, WI)

Plains (IA, KS, MN, MO, NE, ND, SD)

Southeast (AL, AR, FL, GA, KY, LA, MS, NC, SC, TN, VA, WV)

Southwest (AZ, NM, OK, TX)

Rocky Mountain (CO, ID, MT, UT, WY)

Far West (AK, CA, HI, NV, OR, WA)

Indian Country

National

International

How many members do you have:

What other local, regional, national or international coalitions, networks or alliances is your organization a member of?

What is your approximate budget:

Less than $100k

$100k - $499k

$500k - $1M

$1 - $2,000,000

$2,000,000+

Eligibility & Commitments

Please check the following boxes that indicate eligibility below:

We support the Goals, Strategies and Agenda of CJA and commit to engage in work to advance the Campaign (See previous page)

We support the Climate Justice Alliance Manifesto (See previous page)

We support the Climate Justice Just Transition Principles (See previous page)

Should my organization be selected for membership, we will commit to the following (Please check all that apply):

We will adhere to the Jemez Principles for Democratic Organizing (See attached)

We will participate on Full membership monthly calls

We will link the Our Power Campaign website to our social media and on our organizational website

Yes, I agree to pay annual dues before September 1st of every year.

Yes, I agree to participate in a work group and move forward the CJA strategy plan.

If you selected that you will serve on a working group above, please indicate if you will focus on:

Energy Democracy Working Group

Food Sovereignty Working Group

Political Education Working Group

Reinvest in Our Power Working Group

Convenings/Mobilization Planning Groups

Membership Development Committee

CJA staff and Steering Committee members will work with all new member organizations to develop a Memorandum of Understanding to lay out more specific mutual commitments. Please click on the box below if you agree to this.

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