Fall Study & Action Group Sign-up & Inquiry Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete this form to register for the Study & Action groups taking place between October and November 2018.

Email *

First and Last Name *

Phone number

Study & Action sessions will be held on Monday evenings from 6:00-9:00, on 10/8, 10/15, 10/22, 10/29, 11/5, and 11/12. Please indicate your availability. *

I am available and can commit to at least 5 out of 6 of the above dates.

I am available and can commit to 4 out of 6 of the above sessions

I am not available but would like to be informed about the next series when it's scheduled.

Required

Do you have any accessibility needs? If so, please describe here.

For example, are you sensitive to chemicals and other scents? Do you need access to a quiet space during the sessions? Do you need an ASL interpreter or CART transcription?

What is your experience with SURJ and/or other racial justice work? *

There are no wrong answers! Whatever you choose to share here will help your facilitators create a more responsive space.

Please choose the option that best describes your interest *

I'm strongly committed

I'm committed as long as it works with my schedule

I'd like to sign up, but I need more inforrmation first

I'm not able to participate this time, but keep me in the loop about future sessions

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms