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Maryland PPC Volunteer Information Form
Welcome to this movement! Please let us know a little bit about yourself and how you might like to engage. We will follow up to help you get started in this work.
– The Maryland PPC State Coordinating Committee
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Email
*
Your email
Salutation
OPTIONAL: Enter any salutation you wish to be included when we address you in communication (e.g., Mr., Ms., Mx., Dr. Father, Imām, Rabbi, Rev.).
Your answer
First Name
*
Please enter your first name. You may optionally include a middle initial or middle name. Please do not enter any titles/salutations (such as Dr. or Rev.: those go in the previous field).
Your answer
Last Name
*
Please enter your last name. You may optionally include any applicable suffix, such as Jr., Sr., III, or Esq.
Your answer
Student?
*
Are you a student?
Choose
High School
College
N/A
Phone Number
*
Please list the best phone number where we can reach you. Enter it as 10 digits with no punctuation (for example, do not start with a "1" for long distance or use parentheses around the area code or use periods/hyphens). Do not include any direct extensions.
Your answer
Zip Code
*
Please list only a 5-digit zip code (do not list extended zips).
Your answer
Region
*
Please select the region where you live. If you are unsure, refer to the graphic.
Choose
Baltimore
Central
Montgomery
Prince George's
Southern
Western
Lower Shore
Upper Shore
Not in MD
Mailing List
*
Are you currently on the Poor People's Campaign distribution list? If you are not (or you are unsure), please Text Moral to 90975 to join our movement and get all future updates, at both the state and national level.
Yes
No
Unsure
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