Campaign for NY Health - Organizing Pledge 2021
Thank you for being a part of the movement for healthcare as a human right here in New York! Please let us know the ways would like to participate in the coming months to build the movement to #PassNYHealth
* Required
First Name
*
Your answer
Last Name
*
Your answer
Phone
*
Your answer
Email
*
Your answer
Street Address
*
Your answer
City/Town
*
Your answer
Zip Code
*
Your answer
ACTION PLEDGE
I would like to help organize or participate in a meeting with my legislator(s)
Yes
No
Maybe
Other:
Clear selection
If you will help organize a meeting with or participate in a meeting with your legislators, who are your state legislators?
Your answer
I will make a donation to the Campaign for NY Health or ask my organization to donate. (
nyhcampaign.org/donate
)
Yes
No
Maybe
Other:
Clear selection
WHICH REMOTE VOLUNTEER TEAM WILL YOU JOIN?
There will be a supportive training for each activity so that we can each do our best in this difficult time!
Phonebanking Team - mobilize NYHA supporters to take action via phone conversations.
Yes, I will join this team!
Maybe, I want to learn more.
Other:
Clear selection
Textbank Team - mobilizes NYHA supporters to take action via text campaigns
Yes, I will join this team!
Maybe, I want to learn more.
Other:
Clear selection
Social Media Team - shares priority posts, actions, and article from the Campaign for NY Health
Yes, I will join this team!
Maybe, I want to learn more.
Other:
Clear selection
Social Media Content Creation Team - develops shareable content (graphics, toolkits) and engages influencers
Yes, I want to join this team!
Maybe, I want to learn more.
Other:
Clear selection
Language Justice Team - for example: help with outreach to communities, help with content creation for materials, help with translation, help with interpretation
Yes, I want to join this team!
Maybe, I want to learn more.
Other:
Clear selection
Business Engagement Outreach Team - for example: engage current endorsers to provide quotegraphics or do case studies, reach out to new business owner/worker cooperative/self-employed to endorse
Yes, I want to join this team.
Maybe, I want to learn more
Other:
Clear selection
Special Ops Team - I have day time availability and would love to help with short-term projects (phone calls, research, helping to schedule meetings)
Yes, I can join this team and help with special short-term projects
Maybe, I want to learn more.
Other:
Clear selection
ORGANIZATIONAL SUPPORT & COALITION BUILDING
My organization would like to partner with Campaign for NY Health on a training/workshop on the NY Health Act and Healthcare Justice
Yes
Maybe
Other:
I know of organization that I think would want to learn more about the NY Health Act (please indicate in the next field your organization)
Yes
Maybe
Other:
Clear selection
I am part of an organization that can submit a Memo of Support for the NY Health Act to our legislators (we can share a sample)
Yes
Maybe
Other:
Clear selection
Do you want to join the Organizational Outreach Team?
Yes
Maybe
Clear selection
If you checked any boxes above, which organization(s) can you connect to the Campaign for NY Health?
Your answer
Is there anything else you would like to share?
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Campaign for New York Health.
Report Abuse
Forms
