Mask Bloc 603 Interest Form
Name and signal username or phone number
Name
signal username or phone number
Email
example@example.com
1. Do you live in NH or surrounding area?
Yes
No
2. Would you be able to help with distribution/delivery?
Yes
No
3. Would you be able to help with sourcing masks?
Yes
No
4. Would you like to be a lead coordinator?
Yes
No
4. Would you be able to help with dispatch (looking at requests and finding drivers to deliver)?
Yes
No
5. Do you have an interest in community outreach in your area?
Yes
No
6. Do you have experience or interest in design and want to help with online posting or making other art (flyers, zines, etc)?
Yes
No
9. If you can help with delivery/distribution what cities or areas of NH could you help cover?
9. Is there anything else you would prefer to help with or any suggestions you'd like to share?
What aspects of a Mask Bloc are you most interested in (choose all that apply)
Mask and test distribution
Education/community outreach
Activism and collective liberation
Building community with other leftists
Submit
Should be Empty: