Herb and Temple 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
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First Name
Last Name
Phone Number
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E-mail
*
example@example.com
Which Ward, neighborhood, or County do you live in?
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How did you hear about us?
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Please Select
Instagram
One of our organizers
Another community organization
Other (Please specify...)
Have you ever attended one of our gathering, community service events, workshops, or healing practices?
*
Please Select
Yes
No
1) How would you describe your personal values? 2) What impact would you like to have on your community?
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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?
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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?
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Are you committed to building and sustaining revolutionary movement? How would you describe your commitment?
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Which area of our work are you most interested in? (This will help dictate your membership type)
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Spiritual Wellness and Energy Work
Political Education
Community Organizing/ Power Building
Natural Medicine and Food Justice
Community Service
Nationbuilding/Community Infrastructure Development
Liberation work/movement work/Black liberation activism
Land Justice/Geographic Integrity
Principles and Culture of the Movement
Insfrastructure building
Strategy building
Media and messaging
Local politics or systems of governance
Systems of Community Self-Defense
Agriculture
Direct Actions
Advocacy
Other
Are you willing to do monthly community service
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Yes
Maybe
No
Are you willing to work within a radical, God-conscious movement space as an activist, community leader, facilitator, healing practitioner, or organizer
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Yes
Maybe
No
What skillsets or ways of knowing or toolkits do you bring to the movement space/landscape
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Accounting
Advocacy
Alternative Economics
Communications and Messaging
Community Elder
Conflict resolution
Data and Programming
Development and Fundraising
Grant writing
Press and Media work
Landscape Awareness (in the know about whats going on)
Local policy
Media connections
Movement Lawyering
National policy
Civic Engineering
Herbalism
Agricultural skills
Tactical skills
Frontline Respoder
Caregiver
Disruptor
Healer
Visionary
Network Weaver
Storyteller
Well-Connected
Builder/Constructivist
Strategic planning
What is your political ideology? How are you living and practicing this ideology?
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Do you need training as a community organizer/activist
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Yes
Maybe
No
Do you have zero income and are in need of a free membership?
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Yes
Maybe
No
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?
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Do you have dietary restrictions
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Vegan
Vegetarian
Halal
N/A
Gluten-free
Other
Is there anything else we need to know?
Submit
Should be Empty: