2015 Convening Registration Form

Grassroots Convening Registration

Registration closes on October 9, 2015

To be eligible to register, you must be a staff member, volunteer or board member of a California group that has received a grant from the Northern California Environmental Grassroots Fund, the California Wildlands Grassroots Fund or the Community Leadership Project

Please note: You do not have to be a current grantee; all past grantees are warmly welcome.

Fields marked with * are required.

Personal Info

Please enter as XXX-XXX-XXX
Apt, Suite, etc.


If you qualify for a mileage stipend and/or hotel stipend, please complete this section.

Travel Stipend

If you would like to receive a travel stipend, what is will be your one-way mileage to Davis?
(If you are not sure of the mileage, use maps.yahoo.com or mapquest.com.)

If you are traveling more than 50 miles one-way to attend the convening you are eligible for a mileage stipend as listed below (limited to two per group):

  • $50  If you are 51 – 100 miles (one way) from Davis
  • $75  If you are 101 – 150 miles (one way) from Davis
  • $100  If you are 151 – 200 miles (one way) from Davis
  • $150  If you are 201 – 300 miles (one way) from Davis
  • $200  If you are more than 300 miles (one way) from Davis

The travel scholarship checks will be disbursed at the conference when you check in.

Hotel Stipend

If traveling over 200 miles one-way, you are eligible for a hotel stipend of $110. If traveling over 300 miles one-way, you are eligible for a hotel stipend of $220. (Limited to two per group. Please only apply if you need a hotel room. You are responsible for making your own hotel reservation and for paying for your room. We will give you a check when you arrive at the convening.)

Photo and Sound Release

Each group can bring 2 people for free. Additional people cost $25 each (nonrefundable).

Each person attending the convening needs to submit a registration form. Each Group that has received a grant from Cal Wildlands or the Grassroots Fund can bring 2 people for free.

Send checks to: Rose Foundation, 1970 Broadway, Suite 600, Oakland, CA 94612-2218

To pay by credit card, go to Rose Donation Center. Put name of the person for which you are registering in the name line.

Tell Us About Your Group

To provide you with the most helpful content and exercises during our gathering, please answer these five questions. These concern engagement - how you engage with your community in order to raise awareness, motivate action, attract volunteers and raise money - as well as how you tell stories about your work.


Your confirmation is automatically sent to the registration email. You may use this field to send a copy to another email.
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