Anthracite Unite Membership Form
Anthracite Unite is a collective of working class people from Pennsylvania’s anthracite coal region. We’re focused on educating and empowering members of our community and building class unity despite our differences. Interested in becoming a member? Fill out the form below and we will be in touch. To learn more about our work, visit If you have questions, send an email to
Your answer
Your answer
Phone #
Your answer
Address (This will give us a better sense of where our members are located. We'll also use it to send you a free sticker. If you're uncomfortable sharing or don't have a permanent address, entering just your zip code is fine.)
Your answer
Why are you joining Anthracite Unite?
Your answer
Anthracite Unite will be working on several projects in 2020. Would you be interested in getting involved with any of the following? Check all that apply. If you have ideas of your own, mark 'other' and explain.
Do you have particular skills you'd like to put to use to help us grow as an organization? Or skills that you'd like to learn? Again, check all that apply, or add your own.
We're asking that members pay dues, but only to the extent that each of us are able. How much can we count on you to contribute per month as a member of Anthracite Unite? (We'll follow up later with payment instructions.)
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.