#ShutDownDC Earth Day to May Day!

Name *

First Name Last Name

Email *

example@example.com

Phone Number *

Area Code Phone Number

Which days do you plan to take action?

Monday, April 27 - Climate Justice Right Here Right Now: Lifting up local struggles for justice Tuesday, April 28 - Green New Deal Wednesday, April 29 - Hold the Corporations Accountable Thursday, April 30 - Front Line Communities Leading the Fight: Keep Fossil Fuels in the Ground Friday, May 1 - All Out for May Day!

Are you participating with your affinity group or organization? *

What's the name of your group

Great! We'll try to match you up with an affinity group that fits what you want to do and how you want to take action. Tell us a little bit about yourself and what types of actions you're interested in taking during #ShutDownDC and we'll try to get you in touch with a group of people who you can take action with!

Which movements or themes are you excited about supporting

Tell us a little about how much time, capacity and experience you have. Rate each question on a scale of 1-5.

How much experience do you have participating in or organizing direct action

	1	2	3	4	5

1 is This is my first action!, 5 is I've got tons of experience

How much risk are you interested in taking as part of this action?

	1	2	3	4	5

1 is I'd like to avoid risking arrest if possible, 5 is I'm very willing to risk arrest!

How much time can you dedicate to organizing between now and April 22

	1	2	3	4	5

1 is I'm really just available to show up at the action., 5 is I have lots of time and capacity

Which Affinity Group or organization are you part of?

What's the name of your affinity group or organization

Please give us the names, phone numbers and email addresses for three other contacts in your affinity group or organization

Do you have any specific tactics, tools or resources you want to bring to the mobilization?

Is your affinity group open to other people joining?

Yes! Anybody can join! No, we're a closed affinity group. We're open to more people joining but we have some restrictions (for example a woman/femme only affinity group, POC only affinity group, youth only, etc.

Anything else you want us to know??

Yes! I want to receive text message updates from #ShutDownDC!