Group Leader Signup - Roots & Shoots

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Group Leader Signup

The Group Leader membership gives you access to everything you need to make your group's experience rewarding, including full access to our website tools for up to 50 of your members, and the opportunity to create your very own Roots & Shoots group website - and much more!
If you are interested in other membership options please click here.

If you are located outside of the United States, please check our Global Offices listing to see if an office exists in your country. If your country has an office, please contact that office directly to register for membership.

If your group contains more than 50 members please
contact us for pricing & registration.

Group Leader Membership $50 per year ( 1 - 50 members )

Roots & Shoots Group Info

(this info will be available to all site visitors under the 'find a group' section of the site)

R&S Group Name*

No. of members*

(this can be changed later, if needed)

Accepting New Members?*

Yes No

Street Address*

(Will not be displayed)

Address 2

(Will not be displayed)

City*

State/Province*

OR (if state is not in list enter it here)

Zip/Postal Code *

Country *

Group Type *

Date Established

(mm/dd/yyyy)

School Name (if applicable)

Average Member's
Age Range*

(check all that apply)

5 yrs and younger
6-10 yrs
11-14 yrs
15-18 yrs
19-25 yrs
26-64 yrs
65+ yrs

Areas of Interest*
(check all that apply)

Animals

Animal rehabilitation
Animal welfare
Domestic animals
Wildlife and endangered species

Environment

Cleanups
Energy
Gardening
Habitat restoration and tree planting
Nature appreciation
Pollution
Reduce/Reuse/Recycle
Water

Human Community

Disaster relief
Elderly services
Global issues and cultural exchange
HIV/AIDS and disease prevention
Literacy/Tutoring/Mentoring
Peace and conflict resolution
People with disabilities
Poverty, hunger and homelessness

Group Description

Are you willing to answer
questions via email from
R&S members?*

Yes No

Create A Password

Create A Password*

(at least 7 characters long)

Confirm Password*

Remember me on this computer

Your Contact Information

(This information will not be seen by anyone but Roots & Shoots staff)

Email Address*

(Please, do not use the same email address for more than one membership.)

First Name*

Last Name*

Date of Birth*

(mm/dd/yyyy)

Gender

Male Female

Ethnic Background

Click here if your member address info is the same as the group address info above

Address

Address 2

City

State/Province

OR (if state is not in list enter it here)

Zip/Postal Code*

Country*

Home Phone

(include area code)

Business Phone

(include area code)

Cell Phone

(include area code)

Fax

(include area code)

How did you hear
about Roots & Shoots?

eNewsletter	Roots & Shoots Event
Friend or Family Member	Jane Goodall Event
Websearch	Television Show
Brochure/Newsletter	Other

eNewsletter

Check here if you'd like to receive Branch Out, our
monthly eNewsletter.

Terms & Conditions

Yes, I agree to the Roots & Shoots online membership's
terms and conditions

Questions?

Email Us | Call: 800.592.JANE | Write: Roots & Shoots program, the Jane Goodall Institute,
4245 North Fairfax Drive, Suite 600, Arlington, VA 22203 USA

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