Membership Interest Form

Herb and Temple #SacredResistanceMovement Membership Interest Form

for the people. The people invested in our liberation. The people seeking wellness. The people who understand the revolutionary importance of our spiritual healing. the people interested in building community.
Full Name*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Which Ward, neighborhood, or County do you live in?*
How did you hear about us?*
Have you ever attended one of our gathering, community service events, workshops, or healing practices?*
1) How would you describe your personal values? 2) What impact would you like to have on your community?*
How would you describe your relationship with the Creator? Do you follow any religions, spiritual belief systems, or practice any ritual traditions? If applicable, how does this relationship inform your political beliefs, your commitment to the movement, your revolutionary actions, etc? *
What is your political ideology? How are you living and practicing this ideology?*
How would you describe your value-add in the movement? In other words, what do you personally have to contribute to a God-conscious liberation movement invested in building sustainable systems of community care, and ultimately maroon community?*
What skillsets or ways of knowing or toolkits do you bring to the movement space/landscape*

AccountingAdvocacyAlternative EconomicsCommunications and MessagingCommunity ElderConflict resolutionData and ProgrammingDevelopment and FundraisingGrant writingPress and Media workLandscape Awareness (in the know about whats going on)Local policyMedia connectionsMovement LawyeringNational policyCivic EngineeringHerbalismAgricultural skillsTactical skillsFrontline RespoderCaregiverDisruptorHealerVisionaryNetwork WeaverStorytellerWell-ConnectedBuilder/ConstructivistStrategic planning
Are you committed to building and sustaining revolutionary movement? How would you describe your commitment?*
Are you willing to do monthly community service*

YesMaybeNo
Are you willing to work within a radical, God-conscious movement space as an activist, community leader, facilitator, healing practitioner, or organizer*

YesMaybeNo
Please list the names and phone numbers of two elders and one peer or comrade who can vouch for your identity, character, skillset, and values *
Which area of our work are you most interested in? (This will help dictate your membership type)*

Spiritual Wellness and Energy WorkPolitical EducationCommunity Organizing/ Power BuildingNatural Medicine and Food JusticeCommunity ServiceNationbuilding/Community Infrastructure DevelopmentLiberation work/movement work/Black liberation activismLand Justice/Geographic IntegrityPrinciples and Culture of the MovementInsfrastructure buildingStrategy buildingMedia and messagingLocal politics or systems of governanceSystems of Community Self-DefenseAgricultureDirect ActionsAdvocacyOther
Do you need training as a community organizer/activist*

YesMaybeNo
Is there a skillset, toolkit, or tactic you're interested in getting trained up on?
Do you have zero income and are in need of a free membership?*

YesMaybeNo
What is your understanding of nationbuilding/building maroon community? How would you define your relationship to the movement for liberation/what is your personal role in the movement?*
Do you have dietary restrictions*

VeganVegetarianHalalN/AGluten-freeOther
Is there anything else we need to know?
Should be Empty:

Herb and Temple #SacredResistanceMovement Membership Interest Form