Register for EB DSA's May 7 Single-Payer Healthcare Canvass Day
Sunday, May 7th, 12-5pm, 155 Grand Avenue, Oakland CA
Please fill out the form below and we will be sure to contact you about upcoming events and opportunities related to our Single-Payer healthcare campaign. For more information on our campaign, please visit:
https://www.dsaeastbay.org/healthcare/
* Required
First Name
*
Your answer
Last Name
*
Your answer
Email
*
Your answer
Phone
Your answer
Street Address
Your answer
City
Your answer
Zip Code
Your answer
Have you canvassed before?
Yes
No
Clear selection
If yes, tell us about your canvassing or organizing experience:
Your answer
Help us plan transportation
I expect to bring a car and would be comfortable driving others to canvass
I expect to come there on a bike
I'm walking/taking transit/carpooling there/other
Clear selection
Canvassing for single-payer involves walking around for about 2 hours knocking on doors, but some volunteer work also needs to be done at HQ.
Sign me up for canvassing!
I would like to volunteer for sit-down tasks only!
Clear selection
Please check if you are a Spanish speaker:
Yes, I speak Spanish!
We can offer childcare for kids 3-14 years old. Check if you'd like to sign up
I require childcare!
If you require childcare, please list the names and ages of your kids
Your answer
We will be sure to follow up with you about upcoming opportunities, but in the meantime, are there any specific ways you are hoping to contribute?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
