Fight4OurHealth Volunteer Sign Up
Please fill out the information to join volunteer team to defend Affordable Care Act.
Email address *
First Name *
Last Name
Phone Number *
Organization if applicable
Zip Code *
Congressional District if you are a voter
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
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy