Member Engagement Form
You have the power to help individuals across our nation realize their civil rights and eliminate discrimination for generations to come.  By becoming a member of the ERC, you join a community of thousands of people committed to advancing civil rights for all. Once you fill out the form below, we will reach out to you directly to learn more about your desire to get involved.Thank you for your continued support, your dedication to building a more just future is invaluable to the work that we do!
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Email *
Phone Number *
Street 1 *
Street 2
City *
State *
Zip Code *
Preferred Method of Contact *
Required
Are you becoming a member as an individual or are you representing an organization? *
If you are representing an organization, what is it called?
Date of Birth
MM
/
DD
/
YYYY
Gender
Race/Ethnicity
Sexual Orientation
Religion
Disability
Do you use an assistance animal?
Clear selection
Do you require reasonable accommodations? *
Which issues interest you most? (Mark all that apply) *
Required
Please stay connected with us by providing your Twitter handle and Facebook username below:
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms