BVM Louisiana Partnership Form

GENERAL INFORMATION
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address: This is For Shipping Resources, Literature, and BVM Swag

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
ORGANIZATIONAL INFORMATION
Organization Name
Your Role/Title at the Organization
Is your work located in North or South Louisiana?
What is your primary parish?
Parish(es) or Geographic Focus Area
Organization Website or Social Media
Approximate Amount of Organization Employees and/or Volunteers
How long has your organization been active?
What issue areas does your organization focus on? (Check All That Apply)
PARTNERSHIP DETAILS
How would you like to partner with BVM Louisiana?
Briefly describe you or your organization's current priorities or campaigns
Tell us about you or your organization's prior community or organizing work
What other organizations do you partner with or support?
Anything else you'd like us to know?
I agree to be contacted by Black Voters Matter Louisiana about partnership opportunities.
Signature
Should be Empty: