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VA BLOC - Join the Team!
Please fill out this form to join VA BLOC and others in the Hampton Roads Community who want to make a difference!
We are building empowered communities and we need your help!
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First Name
*
Your answer
Last Name
*
Your answer
City
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Your answer
Mobile Number
Your answer
Email Address
*
Your answer
Are you registered to vote?
*
Yes
No
No, I need my rights restored.
Other:
Please select your top two (2) concerns in your community:
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Education
Crime Prevention/Criminal Justice Reform/Dismantling the Pipeline
Mental Health
Women's Empowerment/Women's Rights/Women's Concerns
Redistricting Reform
Voter Registration, Voter Education, & Voter Mobilization
Other:
Required
How did you hear about VA-BLOC?
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VA BLOC Team Member
VA BLOC Website
VA BLOC Social Media Pages
Word of Mouth
Other:
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