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).