BLM Chapter Sign On Request

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Please complete this form if your chapter would like to be added to the signatories of the BLM Chapters Public Statement, and if:

1) You are or have been an active chapter of Black Lives Matter that has engaged any iteration of what is now called the BLM Global Network Foundation ("Foundation"); AND
2) This statement reflects experiences you have had with the Foundation, those who take on the title of co-founders, and/or the leaders of chapters that created Black Lives Matter Grassroots (LA, Long Beach, Michigan, Boston, Toronto, South Bend).

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Your Chapter *

Chapter Email *

Your Name *

Your Email *

Your Cell *

Organizers in chapters with whom your Chapter organizers have experience or relationship (please include the name of organizers and their chapter). *

A brief description of your chapter's experiences that lead you to sign on to the statement. *

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