12/12 Fight For Our Lives - NYC Action Sign Up
We are in the midst of an unprecedented emergency with real human costs. The planet is on fire. People are dying. Instead of figuring out how to align with popular movement demands like a Green New Deal and Medicare for All — which reflect real needs of the masses — establishment Democrats are blaming the left for their own losses. That’s why we’re having an action on Saturday 12/12 to defend & advance our agenda instead. It’s time to antagonize the Democrats for their total failure to win working class support.

Sign up below to get involved planning or supporting the event.
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Email *
Mobile Number *
Zip *
How would you like to participate
Yes
Attend Action
Action Planning/Event Roles
Mobilizing/Turnout (helping phonebank members)
Communications/Social Media
Event Speaker (share your story)
Record a video testimonial (share your story)
Graphic Design
Photographer
Videographer
Clear selection
What's your capacity per week?
Clear selection
Were you affected by the 2008-2009 financial crisis or the failure of the Obama-Biden stimulus?
Clear selection
How? Briefly explain. 280 characters max.
Have you been seriously impacted by the current COVID/financial crisis? E.g. lost your job/healthcare, unemployed, essential worker, can’t afford rent, etc.
Clear selection
How? Briefly explain. 280 characters max.
Have you been personally affected by the climate crisis, e.g. survived a hurricane, flood, wildfire, drought, extreme heat, food scarcity, climate displacement/migration, frequent power blackouts, respiratory illness, live or grew up near polluting infrastructure, etc.?
Clear selection
If yes, please share your story. 280 characters max
Do you work in the fossil fuel industry, utilities, renewables, building trades, mass transit/trucking/freight/shipping, or other sectors that will be deeply impacted by decarbonization?
Clear selection
If so, briefly explain. 280 characters max.
Are you willing to speak to press?
Clear selection
Do you identify as Black, Indigenous, or a person of color?
Clear selection
If you are a union member, which union and local do you belong to?
List 3 dates and times when you are available for an introductory 1-on-1 call with an organizer spaced out over the next month (format MM/DD, XX:XX AM/PM, Timezone) 
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms