Preparing for Nationwide Rebellion
Please fill in the information below to help us make arrangements for the international Rebellion. It is OK to give a provisional or incomplete reply now, then update later. The earlier we have an initial response, the easier it is to plan and to provide additional information.

We may use the information provided on this form to contact you about the Nationwide Rebellion - we won't use it for any other purpose, or share it with anyone else. By completing this form you are consenting to our use of the form in this way. You can contact if you later want your information removed.
Email address *
Preferred Name *
Your answer
Mobile Phone Number
Your answer
When you might be able to attend the protest (tick all that apply):
Arrestability (tick one only):
Travel (tick one only):
Accommodation (tick one only):
Bikes (tick if this applies):
NVDA training *
Affinity Group *
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