Name

First Name

Last Name

Email Address

Phone number (and best time to contact)

Address

Please provide a description of your skills & expertise (e.g. community organizing, anti-racsim workshops, etc.)

Affiliation(s) - (if any)

Position(s) - (if any)

Languages Spoken

Do you identify as Black, Indigenous, or a Person of Color?

What is your ethnicity or cultural heritage?

How did you find out about CTCORE - Organize Now!?