Become an Affiliate webform

fill this out to become an affiliate.

Where is your affiliate located?
How would you describe the community/area your affiliate would represent/organize with?
You can include: race, economic status, national origin, immigration status, sexual preference, gender identity, and age
What are the primary challenges/issues in your community? (Examples: lack of reproduction education, anti-welfare and immigration policies, lack of affordable housing/no tenant rights policies; limited healthcare access; poor working/labor conditions; increased law enforcement violence; high rates of intimate partner/sexual abuse; high rate of violence against LBGTTSQ communities of color and limited resources, lack of leadership development for youth, etc)
Where possible, specify suggested activities
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
3 + 0 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.