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Extinction Rebellion Sign-up Form
(If you're not based in the UK- please fill in the form on the international website-https://xrebellion.org/)
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Name *
City/ Town *
Postcode (First three/four characters)
Phone (please include a space)
In principle, would you be willing to:
Yes
No
Co-facilitate a workshop/training
Help with the campaign organisation
Get arrested
Go to prison for a short time
Take a support role
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Any comments you wish to say about your responses above
Are you involved in any networks or organisations?
Which working group are you interested in? More info on working groups here- https://goo.gl/mfHZPV
If you wish to help with organising, do you have any particular experience or skills?
Would you be interested in dedicating more time to Extinction Rebellion?
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Comments/Feedback
Affinity Group Name (If applicable)
Which event did you attend? (If applicable)
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