Climate Defiance activist form
Signup to take **action** with Climate Defiance
Name
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First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Zip
*
City & state
*
Reference 1 (name, number and email)
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Someone who has known you for over a year and is not a relative. This should IDEALLY be someone in the movement.
Reference 2 (name, number and email)
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Someone who has known you for over a year and is not a relative. This should IDEALLY be someone in the movement.
OPTIONAL: Reference 3 (name, number and email)
Someone who has known you for over a year and is not a relative. This should IDEALLY be someone in the movement.
What can you share to help us know you're a trusted movement member? We work to include as many aligned people as possible, while also keeping out infiltrators seeking to join for the wrong reasons. Help prove you are here for the right reasons!
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Why do you want to be involved in Climate Defiance
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Your twitter handle (write NA if you don't have)
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Your facebook profile (write NA if you don't have)
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Any special skills you'd like to share?
Ex: video; photo; web design; action planning; fundraising; etc.
Your Linkedin profile (write NA if you don't have)
*
Your Insta profile (write NA if you don't have)
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Your tiktok profile (write NA if you don't have)
*
High School and graduation year
College and graduation year
WRITE NA if you are not yet college age or if you did not get a degree.
OPTIONAL: How many hours per week would you ideally like to spend with our org
Please Select
0-5
5-10
10-20
20-40
Submit
Should be Empty: