Fast and Vigil Registration

Your Contact Information
First Name *
Your answer
Last Name *
Your answer
Email Address *
Your answer
Phone Number (to reach you while in DC) *
Your answer
Street Address
Your answer
City *
Your answer
State *
Your answer
ZIP Code
Your answer
Event Logistics
Housing *
Required
Will you join us for the “last supper” on June 28 at 8:30 pm? *
Before starting the fast, we gather for a dinner together. All are welcome - even those not fasting. Details will be sent out later via email and posted on the website.
Required
T-Shirt *
A free t-shirt is included in your registration. Please select your size from the drop-down menu below:
Is this your first time attending? *
Required
Health and Safety
It’s gonna be hot, and you never know what might happen. We seek the following information so that if you have a medical emergency, we can give the paramedics a little more than, “he/she is a good abolitionist.” This information will be held in the strictest of confidence and will only be released to emergency medical personnel in the event that you keel over and need to be carted off. It will be destroyed after the Fast & Vigil concludes.
Will you be fasting? *
Required
Do you have any health concerns we should be made aware of?
List any prescribed medications you are taking, any allergies, and any other medical information that a medical practitioner should know about you in an emergency situation.
Your answer
What is your date of birth? *
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DD
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YYYY
Emergency Contact *
Please list the name of an emergency contact, as well as their relationship to you and the best phone number that can be used to reach them
Your answer
Community Agreement
The statement below is a pledge to commit to non-violence and to the safety of self and community. Please read and respond below:

Our intent is public witness of our opposition to killing by the state. We know and understand that this Fast & Vigil is part of an ongoing, determined campaign to abolish the death penalty. We will use our anger at injustice as a nonviolent force for change.We will act with respect toward those who oppose our point of view. We will respect the decisions of those organizing this nonviolent action. Our attitude as conveyed through words, symbols and actions will be one of respect toward all, including police officers and other government officials, members of the community at large, and all vigil participants.

Accordingly, while participating in the Fast & Vigil:

~ I will carry no weapons
~ I will not vandalize
~ I will not use or carry alcohol or illegal drugs
~ I will not use abusive or insulting language
~ I will not run, or otherwise make threatening motions
~ I will not assault – either verbally or physically – those who oppose or disagree with us, even if they assault us
~ I will protect those who oppose us from insult or attack
~ I will honor the directions of the designated coordinators. In the event of serious disagreement, I will remove myself from the Fast & Vigil
~ I will return to my community and renew my work to end the death penalty.
~ I believe my physical and mental health is generally good, such that my participation presents no threat to myself or others.
~ I agree to stay aware of my health and to look out for the general health and well being of those around me
~ Should I need medical attention, I agree to seek it or leave the event.

Please indicate that you have read and agree to this by checking "YES" below. Registrations will not be accepted without your agreement. *
Registration Fees *
We ask that all participants who are able, to pay a voluntary registration fee of $20, plus housing costs of $15 per night if staying at CCNV. (Not required, but helpful to the cause!)
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