ICLEI Membership Application Form


We look forward to working with you and taking steps together to make your community healthier, happier and more sustainable.

ICLEI Membership Application

Your Personal Information








 

Your Jurisdiction Information













 

Required Contact Information
Primary Elected Liaison Contact Information
What is the role of the Primary Elected Liaison?
The primary elected official serves as key political figure and lead for all elected officials for your community around climate, energy and sustainability work. It is up to the primary elected official as to how engaged he/she is with ICLEI and we welcome on-going communications. Learn More

Primary Elected Liaison Name*

Primary Elected Liaison Title*

Primary Elected Liaison Term End*

Primary Elected Liaison Email*
Primary Staff Liaison Phone

 

Primary Staff Liaison Contact Information
What is the role of the Primary Staff Liaison?
The primary staff liaison serves as the main point of contact for ICLEI resources, technical support and on-going communications. ICLEI members can have multiple staff collaborating with ICLEI and we welcome supporting across all departments and divisions within a member local governments. Learn More

Primary Staff Liaison Name*

Primary Staff Liaison Title*

Primary Staff Liaison Department*

Primary Staff Liaison Email*
Primary Staff Liaison Phone

 

Highest Elected Official Contact Information
What is the role of the Highest Elected Liaison?
The highest elected official is top political figure in the community and is recognized by ICLEI in that capacity.

Highest Elected Official Name*

Highest Elected Official Title*

Highest Elected Official Term End*

Highest Elected Official Email*

Highest Elected Official Phone

 

Billing and Invoice Recipient Contact Information
What is the role of the Billing Contact?
The billing contact is the individual who receives and addresses the annual ICLEI membership invoice.

Billing Contact Name*
Billing Contact Title*

Billing Contact Department*

Billing Contact Email*

Billing Contact Phone*

Billing Contact Address*

 

ICLEI GexComm Voting Contact*Each ICLEI member has opportunity to vote for ICLEI’s Global Executive Committee, the organization’s governing body, and other internal association matters. Of the contacts you provided, who will be your designated contact for ICLEI voting?

 

* = required field