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Your Email:

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Confirm Password:

First Name

Last Name

What level of ROOTS membership do you have?

Rhizome Area Represented (if applicable/ city, state?)

Phone

###-###-####

Who

Members involved, community located in or served and/or partner organizations (Max - 255 characters)

What

The event is...

When

Date

Where

Location/details as you have them (including city and State)

How

How to participate? Is it open to the public/other ROOTers?

Would you like ROOTS to promote the event? If yes, where? (check all that apply)

ROOTS' Facebook Page

ROOTS' Online Calendar In the next ROOTS' Member News (if timing allows)? Communication through ROOTS' mass call/text (ROBOCall) No promotion please

Please make check payable to:

Address you want check mailed to, any special instructions (hold until a certain date, etc.)

ROOTS offers up to $250 for a rhizome event. ROOTers may also use other resources to support regional activity. Please indicate here the amount you are requesting.

What are you social media handles, and or/website?

These will be used in promotion of event.

Do you have a flyer or image for this event? If so please upload. (not required, but helpful.)

Would you like to upload up to 4 more images

Document #2

Document #3

Document #4

Document #5

Have you requested or hosted a Rhizome Before?

If you answered yes, when was this? Also, please describe your Rhizome.

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