Love On Track: First Contact Form

Love On Track: First Contact Form

This form will be used to add your information to a database of community members who are willing and committed to coming together to Unite for the benefit of the Melanin Rich Collective, our offsprings and Supporters who align with our Mission. Information will be stored and used in accordance with GDPR for purposes of Love On Track and only shared with other community organisations with your expressed permission upon written request.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Gender
Area/Country of residence e.g. London/UK
First part of Post Code (UK only)
Do you want to see products and services for Melanin rich communities made by and provided by our communities?

YesNo
Are you willing and able to be part of an active Community Trust, working together to build and provide for our communities where we domicile now and globally?

YesNo
Are you willing and able to volunteer time to be an active member of a task committee?

YesNo
If No, are you willing and able to be a non-active member contributing by way of sharing information, resources I.e. minimum monthly financial donation, networking, attending/supporting fund raising events etc?

YesNo
Are you willing and able to assist with the Self Repair and Healing of our communities by way of collaborating on educational programmes, events and other initiatives that serve our communities?

YesNo
Are you willing and able to attend online meetings?

Yes weeklyYes every 2 weeksYes every monthUnable to attend meetings
Are you willing and able to physically attend meetings (location TBA)?

Yes weeklyYes every 2 weeksYes every monthUnable to attend meetings
Would you like to be added to a Female empowerment whatsapp/telegram group?

Yes WhatsappYes TelegramBothNo
Would you like to be added to a Male empowerment whatsapp/telegram group?

Yes WhatsappYes TelegramBothNo
Are you willing and able to be part of a community patrol in your area and/or travel to support patrols in other areas?

Yes, patrol my areaYes, I'm willing to support other areasNo
Do you own or are you an employee/volunteer for a community organisation, Charity, CIC/CIO or other service provider, including radio station/podcast?

YesNo
If Yes, please provide details:
Do you own a business/provide a product?

YesNo
If Yes, please provide details:
Current/most recent Occupation:
Qualifications/Training:
Use this space to tell us about any skills, talents, knowledge interests you have either qualified or unqualified (e.g. science, astrology, Khemetic Science, traditional spirituality, trade skills, plumbing, carpentry, electronics, gardening, cooking, poetry etc).
Thank you for completing this form. We look forward to building with you and will be in touch with further information. If you would like to contact us please send an email to: admin@loveontrack.org
Should be Empty: