SoCal Days of Action
Fill in this form if you plan to attend the 12/9-11 D4CC Action in San Ysidro. You do not need to be a medical professional to attend! We need all allies and activists for this action.
Email address *
Name (as it appears on your official ID)
Your answer
Name you would like to be called
Your answer
I plan to attend (check as many as you will attend): *we need the most people on 12/10
I am interested in:
Profession/Degree (MD, DO, RN, NP, PA, etc):
Your answer
Medical licenses (list current state licenses):
Your answer
Phone number (required if you plan to participate in direct action):
Your answer
A copy of your responses will be emailed to the address you provided.
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