Name *

First Name

Last Name

Date *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

How can we best reach you? *

Check all that apply

Call

Text

Email

I am most interested in: (check all that apply) *

Board Leadership

Cinco de Mayo

Rita J Martinez Youth Conference

Transforming Justice Project

La Cucaracha Publication and Distribution

Serving on a Planning Committee

Tabling at Community Events

Mutual Aid / Food Distribution / Community Mobilization

Member Communications / Social Media

Administration / Administrative Assisting

Event Security

Custodial Duties

Other