Eco-Logical Bill of Rights, Delegate Registration Form

All Fields Must be Completed.

Other than a delegates' e-mail address which will be shared, REF will not make other delegates' information available without  their permission.

   Name:          E-Mail:

   Address: City:                 State:

   Province: Country:  Postal/Zip Code:

   Phone Contact:                         Occupation:

   Education:                                     Political Affiliation-name of party:

   Religious Affiliation:                                                     I have read the ELBR Introduction:

  I agree to permit my e-mail address to be posted with my contributions and shared with other delegates

Describe experience areas:

Describe(100 words or less), why you wish to be a delegate to ELBR:

After you submit your application, you must pay your registration fee-$20, using the PayPal button on the next page. Or call our office at 303-680-8500, and you may pay via credit card.  Or, print this form and send a $20 cheque to REF at:     PO Box 200400, Denver, Colorado U.S.A.