Salem DSA Interest Form
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Email *
First name *
Middle name
Last name *
Suffix
(like "Jr.", etc.)
Gender pronouns
(e.g. "she / her," "they / them," etc.)
How did you hear about Salem DSA?
 *
Reason for interest
Examples for what to write in here: What brings you to DSA? What do you care about? What are you working on, or what would you like to work on? What other groups do you organize with? What else should we know about you to help you get involved with Salem DSA?
Accessibility needs
What should we know about so we can make our meetings and events more accessible for you? This might include childcare, allergies, dietary needs, physical characteristics of a building, remote electronic attendance, rules for discussion that account for sensory needs, or anything else we should know about to promote accessibility.
Are you a union member?
 *
What do you do for work? Are you seeking work?
*
Are you a student?
 *
Mobile phone
Home phone
Social media profile(s)
Type your handle or paste a link to your Facebook, Twitter, etc.
Contact Preference *
Local Residential Address
Mailing Address (if different)
A copy of your responses will be emailed to the address you provided.
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