2015 Community Village Eligibility Form - Due April 8 - Oregon Country Fair: July 10, 11, and 12
Follow the directions - an incomplete form can lead to ineligibility. Booth Coordinator Notes Required.
To participate in the Community Village, an individual must pass eligibility or belong to an eligible group. Please review the
Guidelines at: www.members.efn.org/~comvill/guidelines.html. Submit this form to your booth coordinator no later than
the April 8, 2015 General Meeting. (Your form must be included with booth forms submitted at the eligibility meeting on
April 13, 2015.) If you choose to mail this form to your booth coordinator, allow ample time for delivery--you are
responsible for ensuring that your form is received by the deadline. Attach a separate sheet of paper if you need more space.
GROUPS: If you are applying for an organization
(or group) SUBMIT ONLY 1 FORM. Answer all the
questions in this column. Be sure to INCLUDE ALL
applying members in the table on the page 3. Complete all
blanks; use “none” or “not applicable” if necessary.
INDIVIDUALS: Answer all questions in this column, and
complete the table on page 3.
Group Name: ____________________________________
May we share your contact information? Note: Your
contact information will not be shared without your
permission.
Circle : Yes
No
Returning Group Only: Last Year of Participation and
Booth:
________________________________________________
________________________________________________
ALL GROUPS must fill out the below information
Your Name:
____________________________________________
Address: ____________________________________
City: ________________________________________
Address: _______________________________________
City: ___________________________________________
State: ______________________ Zip: ____________
Your name: ______________________________________
State: ______________
Zip: ____________
Phone Number: _______________________________
Email: ______________________________________
Group Contact Name: ______________________________
Phone: ___________ Email:________________________
To be included on the CV Drum e-mail discussion list, you
must e-mail your request to [email protected].
Is your group a business, a not-for-profit organization, or
other (please describe)? ____________________________
________________________________________________
Do you want to receive the occasional hard copy post card?
Circle :
Yes
No
Describe group participation or presentations in recent
events (e.g. festivals, workshops, community actions, etc.)
________________________________________________
Please list examples of any activist activities.
_______________________________________________
________________________________________________
_______________________________________________
________________________________________________
How do you contribute to social change and the
community?
________________________________________________
Please list dates your group has met in the past year.
________________________________________________
________________________________________________
________________________________________________
When did your organization form?
________________________________________________
________________________________________________
(Continue on next page, left column)
(Continue on next page, right column)
Community Village Eligibility Form 2015
ALL GROUPS Continued:
INDIVIDUALS Continued:
When did your organization form?
How long have you been doing this and what are your
goals?
_______________________________________________
____________________________________________
Please provide your web address (website, Facebook, etc)
____________________________________________
_______________________________________________
_______________________________________________
What is your mission statement: __________________
____________________________________________
_______________________________________________
____________________________________________
_______________________________________________
____________________________________________
Majority vote ____
Board or leader _____
Describe what you will do to contribute to your booth and
how you will participate in Village during the Fair (e.g.
project, workshop, concept, presentation.)
Consensus ____
Other ______
_______________________________________________
How are group decisions made? Select one:
Does your group partner with other organizations? If yes,
please describe:
____________________________________________
____________________________________________
Explain how an individual joins your organization.
____________________________________________
____________________________________________
____________________________________________
Groups are expected to present workshops, demonstrations,
etc at the Fair. Please describe what your group will present
at the fair?
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
How do you plan to network with other individuals/groups?
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
GROUPS AND INDIVIDUALS: Describe how you or your group further Village values of providing social and
environmental awareness, forums for free communication of ideas, education, information access and networking for
progressive social change.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Do you want your group’s info listed in the CV Directory (CV directory is kept on-site at Info Booth ~ lists
booths and groups in the Village)
Community Village Eligibility Form 2015
NO! ____
or YES, absolutely____!
PASS REQUESTS - This is an eligibility form only and does not guarantee you or your group will receive any passes.
Complete for all group members, family members, etc. that want a pass. YOU MUST COMPLETE ALL INFORMATION FOR ALL THE NAMES LISTED.
GROUPS: Each group is permitted one of the following: 2 worker passes {wristbands} OR 1 worker pass and 3 day passes
OR
6 day passes.
Pass types: Worker (WO), Significant Other (SO), Teen (age 13-18), Youth (age 11-12) or Day Passes (including names if possible)
Vehicle Sticker: SO’s cannot get vehicle stickers. Indicate MAIN or FAR SIDE and you must also indicate if your vehicle is OVERSIZE: longer than 22
feet ($30 more than regular) NOTE: Farside Vehicle stickers available only for those who camped in their vehicle in Far Side last year.
Please write legibly ~ Imagine someone else has to read your writing.
Birth Date is required by OCF for registration. Community Village requires Phone and email (if available).
Vehicle
Community Village Eligibility Form 2015
Sticker
Booth Coordinator eligibility notes (required):
Pass
Type
Name {Please write legibly}
Birth Date
(required)
Address
Phone (required)
Email Address