ANSWER LA (Act Now to Stop War and End Racism): Survey

Endorse May 27 Anti-War Protest

Endorse the May 27
Anti-War Protest

Please fill out this form if you would like to add yourself or your organization as an endorser of the May 27 Anti-War Protest at Obama's Beverly Hills appearance.

*1.

Question - Required - I/my organization endorses the May 27 anti-war protest at Obama's appearance in Beverly Hills.

2.

Please complete the following:

*

Name:

First Required	Last Required

*

Email: Required

Street 1:

City/State/ZIP:

City	State	ZIP

*

Phone Number: Required

Date of Birth:

Month

Day

Year

Yes, I would like to receive e-mail from you about upcoming events and issues.

Yes, I would like to receive postal mail from PEP

3.

Question - Not Required - Cell phone:

4.

Question - Not Required - Please list any organizational or trade union affiliations you have, and if you are a student, what school you attend.

(Maximum response 255 chars, approx. 5 rows of text)

5.

Question - Not Required - Please check all that apply

	I will attend the May 27 anti-war protest.
	I will bring people to the protest and help spread the word.
	I will donate to help ANSWER's anti-war work (donate via PayPal or by check, visit the home page for details).

6.

Question - Not Required - Please use the space below to make comments or ask questions about the protest.

(Maximum response 255 chars, approx. 5 rows of text)