Participant Registration form for XR Global Hunger Strike
Welcome Hunger Strikers, it is incredibly inspiring to see that more than 300 people from 26 countries have signed up to take part in the XR Global Hunger Strike starting Monday!

This will be the first mass international hunger strike for the climate in history. It will lead up to potential mass hunger strikes in the Spring Rebellion and beyond.

Hunger Strikers will sit outside government buildings or iconic landmarks Greta-style, with a sign saying that you are on hunger strike with XR, your country, and which day of the strike you are on.

We ask that you have someone take photos of you sitting with your sign each day and upload them to the Google folder in the welcome link below. The XR global media and messaging team will share your photos with the press and on social media. The result will be a striking collage of climate hunger strikers from around the world.

Please read the full action details here: http://bit.ly/welcomehungerstrikers

For more information email us at: globalhungerstrike@gmail.com

Medical professional approval is required for participants for health and safety reasons. Name, age, and country of Hunger Strikers will be made available to the public through a Universal Declaration and all forms of media through completion.

Conditions apply: http://bit.ly/hungerstrikeconditions
Name, Surname *
Your answer
Email *
Your answer
Phone Number (start with Country code) *
Your answer
Age *
Your answer
Country *
Your answer
Planned city of protest *
Your answer
Do you currently hold Medical Cover/Health Insurance (n/a for UK) *
How long do you plan on hunger striking? *
I understand and agree to all the conditions of participation set out in this link: https://docs.google.com/document/d/1TxMmAtjJeTDgjknNeeKb4ibprVdOD-k8C2rlmXYwK24/edit?ts=5d90c9ae *
Depending on the requirements in my country, I understand that I must fill out this medical form to participate and have my name on the Universal Statement of this action: https://forms.gle/q4gEEbcUnz5WchNv6 *
Required
By signing my full name below I agree that all information above is correct and that I will inform XR Global Hunger Strike of any changes *
Your answer
I give my consent to XR GHS to get in touch with me using the information I have provided in this form, for the purpose of organising events and providing updates. I understand I can opt out of this agreement, request to have my data deleted from XR GHS’ spreadsheets, and am entitled to receive a copy of my data at any time by emailing globalhungerstrike@gmail.com.
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