Fight4OurHealth Volunteer Sign Up
Please fill out the information to join volunteer team to defend Affordable Care Act.
Email address *
First Name *
Your answer
Last Name
Your answer
Phone Number *
Your answer
Organization if applicable
Your answer
Zip Code *
Your answer
Congressional District if you are a voter
Your answer
Are you willing to join phone banks? *
Required
Are you willing to make calls at home with Virtual Phone Bank (VPB)? *
Are you willing to be on our Rapid Response team? If yes, please give us your prefered contact method.
Pick activities you are interested
Comment
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service