CleanBC Indigenous Engagement Sessions on Climate Action Survey

1.By indicating ‘yes’ below, I consent to the disclosure of my contact information to other Natural Resource Ministries for the purpose of contacting me for further climate related engagements. I also consent to the temporary storage of the feedback I give in this session on SurveyMonkey servers. I understand that these servers may be accessed from outside of Canada. This consent is valid from this date forward, and may be revoked by contacting Anna Bunce, Senior Policy Analyst at anna.bunce@gov.bc.ca. If you would like to register but do not consent to sharing your information please contact Kristy Joe at kristy@alderhill.ca or 250-280-8486 to register for the event.(Required.)

Yes

2.First Name(Required.)

3.Last Name(Required.)

4.Title/Occupation

5.First Nation, Indigenous Nation or Indigenous Organization you are associated with

6.Contact Information (You will receive a zoom link emailed to the email address you provide here)(Required.)

Email Address

Phone Number

8.Do you have any suggested questions you think we should ask attendees at these engagement sessions?

9.Is there anything else you would like to share with us prior to these sessions? (Topics of interest, important context etc.)

10.We are offering one payment of $250.00 to each Nation or Indigenous organization that has representatives in attendance at any of the CleanBC engagement sessions happening from January 28th to March 2nd, 2021. A cheque or electronic funds transfer will be sent to the Nation or Indigenous organizations after the engagement ends in March. This is in acknowledgement of your time and contributions to the development of the Province's climate policies and programs.

Please check this box if the payment is to go to the Indigenous Nation or Indigenous Organization indicated above OR provide additional information here:

Additional Information

11.If payment is to go to an Indigenous Nation or Indigenous Organization, do you have access to their GST number? If possible please provide below: (not required but we encourage to have quick access to it for a follow up phone call or email)

12.Do you self identify as a Youth or Elder?

Yes

No

A $50 payment will be offered to you in acknowledgement of your time and contributions to the development of the Province's climate policies and programs. The cheque will be issued and mailed to the information provided in this form. If different from above, please provide your legal name and mailing address below: