Name

Email Address

Mailing Address

Website (eg. www.yoursite.com)

How did you hear about Indigenous Peoples Power Project? (Social Media, Family, Friend, Colleague?)

Are you affiliated with an Organization, Project, Tribe or Indigenous group? If so, with whom?

Are there environmental impacts in your region that affect you or your community? If so, please describe in a few words.

Are there others in your region outside of your community affected by environmental crisis that IP3 Action should know about? If so, who?

Do you or your community have experience in Nonviolent Direct Action? If so, please describe.

How many people do you anticipate training with IP3 Action?

Do you have any additional comments, input, or details you'd like IP3 Action to know about?

Which training sessions or support are you interested in? (Please check all that apply) Which training sessions or support are you interested in? (Please check all that apply) Nonviolent Direct Action (NVDA) Creative Resistance Climbing Blockades Wellness on the Frontlines Security Culture Other

Do you or your organization have a training budget? Do you or your organization have a training budget? Yes No

Are you interested in becoming a Nonviolent Direct Action (NVDA) trainer in the IP3 network? Are you interested in becoming a Nonviolent Direct Action (NVDA) trainer in the IP3 network? Yes No Maybe

Are you interested in attending an in person Action Camp in the future? Are you interested in attending an in person Action Camp in the future? Yes No Maybe

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