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Chicago Activism Form
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Organization Name
*
Your answer
Website Address
Please provide the full website address for your organization
Your answer
Which of the following describes your organization?
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Choose
Business
Governmental
Grassroots
Militia/Military
Neighborhood/Community
Non-Profit
Political Party
Public
Religious/Spiritual
Special Interest
Student Group
Union
Option 13
What best describes your cause/purpose?
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Choose
Agriculture
Art
Business and Commerce
Civil Liberities
Cultural and Ethnic
Economic Justice
Education
Emergency Response
Energy
Enviornment
Finance and Money
Global Relations
Government/Democracy
Housing
Human Rights
Immigration
Labor
Law
Media
Military
Peace and Justice
Prison
Religious/Spiritual/Psychological
Security and Law Enforcement
Social Service/Civic Engagement
Technology, Science, and Industry
Transportation
Other
Please describe your organization's misson/purpose.
Your answer
Email
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Phone
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Fax
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Address (Number and Street)
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City
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State
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Zip Code
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Facebook Page
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Twitter
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YouTube
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Flickr
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RSS Feed
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Newsletter
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Event Page
Your answer
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