Replenish 2024 Nomination Form

Please Note: As of June 27, 2024, applications are closed. All submissions moving forward will be added to our waitlist. You will receive further communication if your waitlisted submission progresses. Thank you.

Thank you for your interest in Replenish!

This gathering is committed to solutions centred on the voices, needs, and leadership of Indigenous folk who have been disproportionately impacted by the climate crisis.
If you prefer to have a conversation or submit a video or voice file rather than fill out the form, please contact Orane at orane@hollyhock.ca

Your application will be reviewed by the Replenish Advisor Circle (Kim Haxton, Melina Laboucan-Massimo, Jen Wickham, Odette Auger). We will be in touch within 4 weeks with the status of your nomination.

Are you referring yourself or someone else?*

Nominee's First Name*

Nominee's Last Name*

Nominee's Email*

Phone Number*

Nations or Communities:

Please share about this person’s work in the world, and any organizations or communities they support.

How did you hear about Replenish?