Southern Movement Committee Membership Form
Thank you for expressing interest in joining the Southern Movement Committee. Please answer the following questions below, and we will contact you with the next steps.
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First Name *
Last Name *
Pronouns - We ask for pronouns to know how to refer to you in conversation. Ex. she/her, he/him, they/them, or your name.
 *
Age
 *
Are you Black and/or African American? *
Ethnicity (ex. African American, Native American/Alaskan Native, Pacific Islander, Asian, and Native Hawaiian) or nationality *
Phone Number 
 *
Email Address
 *
What is your current zip code?  *
Shirt Size
 *
Please give us a few times to meet in the next few weeks to meet to discuss membership in the Southern Movement Committee.  *
What skills do you want to bring to the Southern Movement Committee?
 *
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