Raise Up 2017 Event Report
Please submit this form as soon as possible after each signature collection event. Please report all of the signatures collected at an event on a single form, even if voters from more than one city or town signed petitions during the event.
Your First Name *
Your answer
Your Last Name *
Your answer
Your Phone Number *
If you've already given us your phone number on 2017 Event Reports one or more times, an "X" in this field will do fine.
Your answer
Your Email Address *
If you've already given us your email address on 2017 Event Reports one or more times, an "X" in this field will do fine.
Your answer
Event Date *
Click on the down-pointing triangle at the right side of the date box, and then click on the date of the event. If the event lasted more than one day, enter the last day. Please do not enter a date after 11/19/17.
MM
/
DD
/
YYYY
Event City or Town *
In what city or town did most of the activity occur? To find a name in the list, type the first letter, and then use the scroll bar to find the name.
Event Place
Where did the event occur? Examples might be "Shaw's Supermarket" or "Main Street" or "UMass Lowell student center"
Your answer
Number of Voters who Signed a Minimum Wage Petition *
These petitions have a large letter B in the bottom right corner.
Your answer
Number of Voters who Signed a Family Medical Leave Petition *
These petitions have a large letter C in the bottom right corner.
Your answer
Number of Volunteers *
How many people, including yourself, helped collect signatures? For an event that lasted more than two hours, indicate the AVERAGE number of people who participated at any time.
Your answer
Who Organized this Event? *
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