participate

Part 1: Personal Details

Name *

First

Last

Email *

Phone

Local Group (eg XR Mid Coast)

Address

Address Line 1

City

State / Province / Region

Postal Code

Part 2: Actions

Would you like to participate in our non violent direct action?

Are you prepared to be arrested?

Might you be prepared to go to prison?

Would you be interested in these specific roles during an action?

Wellbeing
Arrestee Support
Legal Observer
Marshall

Part 3: Organising

Would you be interested in organising with XRMC?

How much time do you have to commit?

An evening or two
Part time (15-25 hours)
Full time (35+ hours)
Other time - comment below

Or other time

What group/s would you be interested in joining?

Part 4: Data Protection & Consent

By ticking this box I give my consent to Extinction Rebellion Mid Coast to get in touch with me using the information I have provided in this form for the purposes of news, updates and rebellion. *

I consent

Part 5: Comments

Do you have any specific skills you would like to offer?

Any other comments:

Captcha *

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