NC Call to Action for Palestine: Debrief Form
Thank you for contacting your legislator and the NC Governor. We want to document your experience and track our impact. All information you share is encrypted and will not be seen by anyone except our data and field team. Have more questions? Email us at muslimwomenfor@gmail.com or call text: (919) 300-6710
Full Name
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First Name
Last Name
Phone Number
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E-mail
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example@example.com
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Ethnic Origin (be specific)
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How did you contact your legislator?
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Please Select
Phone Call
Email
Both
If phone, did you talk to someone?
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Please Select
Yes
No, it went to voicemail
No, the line was disconnect
No, voicemail was full
I didn't call
If you emailed, please detail the response you recieved, if any
Please enter any questions on your mind or concerns that you do not see listed on the form
How was your experience overall? Please be detailed.
Please enter any questions on your mind or concerns that you do not see listed on the form
Can we contact you regarding your experience?
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Yes
No
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