2021 Poor People's Moral Action Congress Registration / REGISTRACION PARA EL CONGRESO ACTION MORAL 2021 DE LA CAMPAÑA DE LOS POBRES

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Delegates should use this form to register for the Poor People's Moral Action Congress on October 15, 16, 18, and 23rd.

First Name / Primer Nombre *

Last Name / Apellido *

State / Estado *

Email Address / Correo Electrónico *

Phone Number / Numero de Telefono *

If you are on a State Coordinating Committee, what is your role? / Si eres miembrx de un Comité Coordinadorcual es tu posición?

If you are not currently serving on a State Coordinating Committee, who invited you to this training? / Si no eres miembrx de un Comite Coordinador, ¿Quien te invitó a este entrenamiento? *

Are you a member of a partner organization? If yes, please list it here. ¿Eres miembrx de una organización Aliada? Si es así, cual?

How can we ensure that you are fully able to participate in this Congress? ¿Cómo podríamos asegurar su completa participación en este congreso?

ASL interpretation / Interpretacion de lenguage de señas (ASL)

Spanish interpretation / Interpretacion al Español

Otro

Other:

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