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Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
State*
County, if in Kentucky
Current opportunities I am interested in:*

Learning more via email or text about community defense in central KentuckyAttending trainings related to community defenseLearning more via email or text about mutual aid in central KentuckyNone of these
Possible future opportunities I am interested in:*

Organizing with my neighbors to create a safer neighborhoodAttending trainings related to mutual aidGiving to or raising money for mutual aid in central KentuckyParticipating in mutual aid activities, like delivering foodRallies or protests in support of our most vulnerable neighborsNone of theseOther
Tell us more: Why do you want to be involved with community defense and/or mutual aid in central Kentucky?
What language(s) do you speak fluently?

ArabicEnglishFrenchHaitian CreoleHindiJapaneseKoreanMandarinNepaliPortugueseSpanishSwahiliKinyarwandaOther
Where did you hear about this sign-up form / who referred you to our webpage?*
If you use the Signal app, what is your Signal username, and/or what is your personal Signal link?
A Signal username starts with @ and ends with numbers. You can find this or your link in the settings of the Signal app.
Should be Empty: