Act Now to Stop War & End Racism (ANSWER) - Los Angeles: Survey

Oct. 7 & 17 Transportation

Organizing Center/ Transportation Form

Filling out this form means that you/your organization will be an Organizing and/or Transportation Center for the October 7 U.S. Out of Afghanistan Protest in Los Angeles, and/or the October 17 Anti-War Teach-In.

ORGANIZING CENTER: If you agree to be an Organizing Center, you will receive flyers/posters to distribute in your city, school, community, place of worship, union or workplace. You will be a source of info to people in your area about the October anti-war actions.

TRANSPORTATION CENTER: If you agree to be a Transportation Center (you can be both an Organizing and Trasportation Center), that means that you will work with other people and groups in your area to bring people to Los Angeles on October 7 and/or October 17.

*1.

Question - Required - I/my organization

	will be an Organizing Center for the October 7 U.S. Out of Afghanistan Protest in LA.
	will be a Transportation Center for the October 7 Protest.
	will be an Organizing Center for the October 17 Teach-In.
	will be a Transportation Center for the October 17 Teach-In.

Information to list on ANSWER-LA web page:

*2.

Question - Required - Name (or name of group)

*3.

Question - Required - Email

4.

Question - Not Required - Phone

*5.

Question - Required - City/State/Zip

6.

If you do not want all of your information publicized, but you can provide it for communication with ANSWER organizers, please fill out the below blanks:

*

Name:

First Required	Last Required

Email:

Street 1:

Street 2:

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

Remember me. What's this?

7.

Question - Not Required - School/community/place of worship/union/workplace or other

8.

Question - Not Required - Provide details about your Organizing Center and/or Transportation plans (including the type of transport, time of departure and arrival, cost and how to buy tickets, etc.):

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

9.

Question - Not Required - Additional questions or comments:

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