VoteNoBailout.org: Survey - Endorse the Oct. 2 Demonstration at the Capitol

Endorse the Oct. 2 Demonstration at the Capitol

1.

Please provide the following:


*	First Name: Required
*	Last Name: Required
*	Email: Required
	Street 1:
	Street 2:
*	City: Required
*	State / Province: Required
*	ZIP / Postal Code: Required
	Country:
	Phone Number:
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2.

Question - Not Required - Organization/Union/School (write out all acronyms)

(Maximum response 255 chars, approx. 5 rows of text)

3.

Question - Not Required - Title/Position

(Maximum response 255 chars, approx. 5 rows of text)

4.

Question - Not Required - Please list me as an endorser Yes
No

5.

Question - Not Required - Please list my organization/union: A) As an official endorser
B) For identification purposes only, next to my name
C) Don't list my organization

6.

Question - Not Required - I can help with (check all that apply):

	Outreach (distributing flyers, posters, and stickers)
	Fundraising
	Organizing an event in my area

7.

Question - Not Required - Send us your comments and ideas!