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Roc NORML New Member Form
After you have made a donation to Roc NORML (
https://square.link/u/DeKdx1Aw?src=embd
), fill out the form below to finish the process to become a Roc NORML member.
If financial difficulties prevent you from making a donation at this time, please select the appropriate choice below to become a member.
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Today's Date
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First Name
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Your answer
Last Name
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Your answer
Pronouns
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He/Him
She/Her
They/Them
Email Address
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Your answer
Zip Code
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Your answer
Phone Number
Your answer
Membership Donation
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Basic ($10)
Advocate ($20)
Friend ($40)
Beneficiary ($100+)
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Payment Information
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https://square.link/u/DeKdx1Aw?src=embd
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What's the best way to contact you?
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Email
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Phone - Text
How did you hear about us? (select all that apply)
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Facebook
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Roc NORML Website
Radio
Flyer
Friend/Family/Colleague
Another non-profit organization
At an event
Other:
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Select your age range
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18-29
30-49
50-69
70+
Prefer not to answer
Select all ways in which you identify yourself:
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Parent
Caregiver
Veteran
Entrepreneur
Medical Professional
Medical Cannabis Program Patient
Educator
Non-cannabis Consumer
In recovery from drugs and/or alcohol
Previously arrested or charged with a marijuana related offense
Friend(s) or family member(s) previously arrested or charged with a marijuana related offense
Active social media user (Facebook, Instagram, Twitter)
Other:
Required
What would you consider your knowledge level regarding cannabis/marijuana legalization in New York State?
Basic
Intermediate
Advanced
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What topics would you like to learn more about?
Your answer
Are you interested in being a sponsor (monetary, services, or goods) for Roc NORML?
Yes, please send me more information about sponsorship opportunities
No
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Are you interested in volunteering for Roc NORML?
Yes, I am interested in learning more about volunteer opportunities for Roc NORML (Someone from Roc NORML will email you sometime in the next 2 weeks with more information about volunteer opportunities - your response will be required, so please watch for this email!)
No, not right now
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