Sign up for the 2011 Prisoner Procession and Fast

Name: *

Email: *

Your Contact info: *

Are you willing to wear a jumpsuit in J11 prisoner procession: *

yes

no

are you willing to risk arrest on Janaury 11th?: *

yes

no

do you want to help in the planning by joining a working group?: *

yes

no

Are you participating in the fast from Jan 11-22?: *

yes

no

Will be be staying in DC?: *

yes

no

If you're not staying in DC, please let us know in what city you plan to fast.:

Are you part of a group / organization that you would like identified?:

Short bio:

Short "why I am participating":

Can you commit to alerting your congregation? community? family? (we will provide a template letter soon):

Do you have any local media contacts? (we will provide a template soon):

can you raise 50$ towards the campaign?:

yes

no

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