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C4L Leadership Interest Form
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First Name
*
Your answer
Last Name
*
Your answer
State
*
Your answer
County
Your answer
Primary Email Address
*
Your answer
Phone Number
Your answer
Have you completed a profile for a Member Account on the Campaign for Liberty website?
Yes
No
Clear selection
Are you willing to use your given name as your User Name on the website?
Yes
No
Clear selection
What level of leadership are you most interested in pursuing?
*
Note: Local Coordinators organize in their own neighborhood, County Coordinators organize at the county level, and State Coordinators organize at the state level.
Local Coordinator
County Coordinator
State Coordinator
Unsure
What is your prior activism experience, if any?
Your answer
Please list the names of any other activist organizations you belong to, and/or positions you hold.
Your answer
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