JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Blackjewel Solidarity
Please fill out your interest in supporting the miners in Harlan County.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name
*
Your answer
E-mail
*
Your answer
Phone
*
Your answer
Address (location, and chapter if applicable)
*
Your answer
Yes, I will donate this amount:
Your answer
Yes I can offer supplies (Ice, Tarps, Solar Lanterns, Camping Chairs, Water Jugs, Anything that can go into their free store)
I will go in person to deliver
I can send them or pass off to someone to bring please give me more info
Clear selection
Supplies that I will offer will cost this much (estimated amount is fine)
Your answer
I am interested in going and can help in this area:
Camp kitchen
Security and Safety
Free store
Watching the train
Any of the above, wherever help is needed.
Clear selection
If you are planning to go have you had experience in similar situations? (direct solidarity, encampments, blockades, strikes)
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Showing Up For Racial Justice.
Report Abuse
Forms
