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Only enter if applying for a Regional Affiliate membership

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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.

Primary Elected Liaison Name *

Email *

Primary Elected Liaison Title *

Primary Staff Liaison Phone *

Primary Elected Liaison Term End *

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.

Primary Staff Liaison Name *

Primary Staff Liaison Email *

Primary Staff Liaison Title *

Primary Staff Liaison Phone

Primary Staff Liaison Department *

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 Email *

Highest Elected Official Title *

Highest Elected Official Phone

Highest Elected Official Term End *

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 Email *

Billing Contact Title *

Billing Contact Phone *

Billing Contact Department *

Billing Contact Address *

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Primary Elected Liaison Contact Information

Primary Staff Liaison Contact Information

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