JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Greater Lafayette DSA Interest Form
Get involved with Greater Lafayette DSA
Sign in to Google
to save your progress.
Learn more
* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Pronouns
Your answer
Mailing Address
Your answer
Zip Code
Your answer
Email
Your answer
Phone number
Your answer
How would you prefer to be contacted?
Email
Phone
No Preference
Clear selection
Which of the following best describes you?
Employed
Seeking Employment
Retired
High School Student
Undergraduate Student
Graduate Student
Other:
Clear selection
Who is/was your school or employer?
Your answer
Occupation
Your answer
Who is your landlord / property management company? (Please write "own", or other brief description if you don't rent)
Your answer
Have you officially joined the national organization of DSA at
https://act.dsausa.org/donate/membership
? We recommend signing up as a monthly sustainer, as this helps support the local chapter financially.
Yes
Not yet
Clear selection
Are you a member of the Purdue chapter of Young Democratic Socialists of America?
Yes
No
Clear selection
How did you hear about us?
Friend
Flyer
Event
Instagram
Twitter
Facebook
gldsa.org
GLDSA Campaign (e.g., Living Wage Campaign, Medicare for All)
Other:
Clear selection
Are you interested in receiving occasional updates from our mailing list?
Yes
No
Clear selection
Comments
Your answer
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
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
