Kavod Membership Census 2021-2022
Thank you for affirming your support for the Kavod community and building power with us by becoming a Kavod member!
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First Name *
Last Name *
Birth Date *
MM
/
DD
/
YYYY
Phone number *
Email address *
Street Address *
Include house#, street, apt#
City *
State *
Zip code *
Tell us about yourself
Check as many as apply to you in the checkbox questions. All questions are optional.
Racial and ethnic identities
Gender Identity
Gender pronouns (e.g. she, he, they, he/she) or a short description of your gender identity
Do you identify as a person with a disability/a disabled person?
I grew up... ( See the definitions next to each class option for guidance.)
Occupation
How do you spend your days?
Are you part of a union in your workplace?
If you said yes or are part of a union in some form, what union are you a part of? What is your role in the union (member, steward, staff, in leadership, etc.)?
Anything else you want to share about yourself or your identities?
If you are a new member, tell us how you found your way to Kavod:
Thank you for your contribution to your Kavod membership. Please let us know the amount of your donation here.
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