Contact information
The National Egalitarian Republic & Democratically Socialist (NERDS) Party Member Petition Signup
Email address *
Your Full Name *
Your answer
Your Preferred Online Handle (Username/Screen Name)
Your answer
Your Age *
Your Sex/Gender Identification *
Your Sexual Orientation *
Your Ethnicity *
Are you currently registered to vote? *
What is the city, county, and state of residence where you're currently or would be registered to vote? *
Your answer
Do you agree to sign up in becoming a basic member of The NERDS Political Party? By checking "Yes" you agree that you have provided your virtual online signature. *
Required
Which of our party platform agenda principles interest you the most? *
Required
Do you have any interest in becoming an ELITE MEMBER of The NERDS Political Party? Basic members can only vote to elect official party members running for office and on our issues and agendas. Silver members have the ability to post and discuss our agenda on our forums. Gold members have the ability to participate in teleconferencing debates and discussions. Platinum members have the ability to become candidates running for office. You'll be notified separately when we're ready to accept membership fees. *
Do you have the desire in becoming a volunteer for our party? If so, please fill out your address and phone number in the next sections and describe how you desire to help our party as a volunteer.
Your answer
Your Address
Your answer
Your Phone Number
Your answer
Please provide any additional comments or opinions in this section.
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of NERDS OSD. Report Abuse - Terms of Service