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Registration for YOUR VOTE DOES MATTER
Presented by VA BLOC and hosted by Ivy Baptist Church
Monday, September 26th 7:00p-8:30p
Ivy Baptist Church - 50 Maple Ave, Newport News, VA 23607
Please fill out this form to register.
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First Name
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Your answer
Last Name
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Your answer
Street Address
Your answer
City
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Your answer
State
Your answer
Zip Code
*
Your answer
Are you interested in learning more about VA-BLOC and how YOU can get involved?
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Yes
No
Maybe
How did you hear about this event?
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Internet/Website
Social Media
VA-BLOC Team Member
Other:
Required
What are your top three (3) concerns in your community?
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Education
Criminal Justice Reform/Dismantling the Pipeline
Economic Security
Mental Health
Community Policing/Violence Prevention
Environmental Justice
Other:
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Are you registered to vote?
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Yes
No
No, I need my rights restored.
Other:
Are you a college student?
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Yes
No
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