VA BLOC Builders
Please fill out this form to join VA BLOC and others in the Hampton Roads Community who want to make a difference!
We are building empowered communities and we need your help!
First Name *
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Last Name *
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Street Address *
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City *
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State *
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Zip Code *
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Phone Number
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Email Address
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What is your age range? *
Voting Precinct
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Are you registered to vote? *
Please select your top three (3) concerns in your community: *
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For you to attend a meeting or event, what would be the best times? Check all that apply. *
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How did you hear about VA-BLOC? *
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