Medicare for All Canvassing Sign Up
Thank you for choosing to sign up to canvas for the Chicago DSA's Medicare for All campaign!

Though canvassing we hope to build our people power to pressure our politicians to put in place a single, universal system with comprehensive coverage that is free at the point of service.

Please enter your contact information and days you're available to canvas below. If your plans should change, please return to this form and resubmit it using the same email you provided previously. If your plans change the day of or the day before the canvas please contact Luke Kula at or (847) 863-6235.

Email address *
Phone number *
Please enter as (XXX) XXX-XXXX
Your answer
Full name *
Your answer
Dates & locations planning to canvas
Please note that all days for canvassing are on Saturdays and run 12pm to 3pm.
Blue Line - Division
Pink Line - 18th
October 13th
October 20th
October 27th
November 3rd
November 10th
If you're only available for certain hours between 12pm and 3pm, please note it here. Be sure to include which dates & locations for which you are unable to stay the whole time.
Your answer
Thank you for signing up to canvas!
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service