ANSWER Coalition Los Angeles (Act Now to Stop War and End Racism): Survey

Endorsement/Volunteer Form

Please fill out this form if you or your organization would like to endorse Oct. 7,
or if you can volunteer to help build the action.

Friday, Oct. 7, 4:30pm
Protest & Die-In
10th anniversary of the
Afghanistan War

Westwood Federal Building
11000 Wilshire Blvd.
Los Angeles, CA

1.

Please complete the following:

*

Name:

First Required	Last Required

*

Email: Required

Street 1:

*

City/State/ZIP:

City Required	State	ZIP Required

*

Phone Number: Required

If you respond and have not already registered, you will receive periodic updates and communications from PEP.

2.

Question - Not Required - IMPORTANT *for your listing*: In the box below, please type exactly how you would like the endorsement you are submitting to appear on our website. To indicate that an organization did not endorse but is listed for your personal affiliation, put an asterisk (*).

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

3.

Question - Not Required - Title, position, role (in entity listed below):

4.

Question - Not Required - Organization, School, Union:

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

5.

Question - Not Required - Please select one if you have listed an organization above: (A) My organization has officially endorsed - please list only the organization name.
(B) My organization has officially endorsed - please list my name, position and the organization.
(C) I have personally endorsed and listed my organization for my personal identification; my organization has *not* endorsed.

6.

Question - Not Required - What days can you volunteer to build Oct. 7? (You can check multiple days!)

	Monday
	Tuesday
	Wednesday
	Thursday
	Friday
	Saturday
	Sunday

7.

Question - Not Required - In addition:

	Please mail me flyers and posters to distribute in my area. (Note quantity of each in comment field below.)
	I will pick up flyers and posters at the ANSWER Office.
	I will organize transportation to Oct. 7 from my neighborhood/school/area.
	I will help with fundraising.
	I would like someone from ANSWER to speak to my group or classroom (explain in comments).

Click here to donate and help make Oct. 7 and ANSWER's ongoing anti-war work a success.

8.

Question - Not Required - If you will organize transportation to Oct. 7 in LA, please list the type of transportation (bus, van, carpool, vanpool, metro, etc.) and the time and location you will meet.

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

9.

Question - Not Required - Comments:

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

Oct. 7 Protest & Die-In