The BlackElectorate.com Community Development Initiative On Street Organizations and Youth Development

Name:

Phone Number:

Email:

Occupation:

City:

State:

I would like to receive regular e-mail updates regarding this Initiative:
Yes No

I have the following amount of time to commit each month to assist with this Initiative:
20 hours 12 hours 8 hours 4 hours 0 hours

I am willing to email those in my network regarding this Initiative:
Yes No

I am willing to make phone calls and write letters to elected officials regarding this Initiative:
Yes No

I am willing to contribute financial resources to organizations working on this Issue independently and in association with this Initiative:
Yes No

I am willing to attend events and participate in conference calls in association with this Initiative:
Yes No

I am willing to work closely 'on the ground' with individuals and organizations working on this issue and Initiative at the local or 'grassroots level.':
Yes No

I am willing to conduct scholarly research and assist in the writing of 'white papers,' 'editorials/opinion editorials,' and 'talking points' for opinion leaders, elected officials, and activists who give interviews and make appearances on Black, Alternative, and Mainstream media outlets:
Yes No

I am willing to distribute and disseminate such 'white papers,' 'editorials/opinion editorials,' and talking points':
Yes No