New Chapter Application

Please use the following form to submit your registration as a chapter of Humanity+.

Chapter name
If your chapter does not have a specific name, just name it after your location.
Chapter website
Chapter location
State or Province (if applicable)
Number of members (approximate)
Leader's name
Leader's e-mail address
Leader's phone number or Skype handle
Next meeting date
Next meeting location
Other information

Please enter the text you see in the corresponding image