First Name* Last Name* Email (Primary)* Phone* Address* City* State* – select –AguascalientesAlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasArmed Forces AmericasArmed Forces EuropeArmed Forces PacificBaja CaliforniaBaja California SurBritish ColumbiaCaliforniaCampecheChiapasChihuahuaCoahuilaColimaColoradoConnecticutDelawareDistrict of ColumbiaDistrito FederalDurangoFloridaGeorgiaGuamGuanajuatoGuerreroHawaiiHidalgoIdahoIllinoisIndianaIowaJaliscoKansasKentuckyLouisianaMaineManitobaMarylandMassachusettsMexicoMichiganMichoacinMinnesotaMississippiMissouriMontanaMorelosNayaritNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundland and LabradorNorth CarolinaNorth DakotaNorthern Mariana IslandsNorthwest TerritoriesNova ScotiaNuevo LeonNunavutOaxacaOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandPueblaPuerto RicoQuebecQueretaroQuintana RooRhode IslandSan Luis PotosiSaskatchewanSinaloaSonoraSouth CarolinaSouth DakotaTabascoTamaulipasTennesseeTexasTlaxcalaUnited States Minor Outlying IslandsUtahVeracruzVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingYucatanYukon TerritoryZacatecas Zip Code* What is the best way to reach you? Phone Email Postal Mail SMS Fax What issues are you interested in working on? Agriculture Art Globalization Immigrant Rights Labor/Worker’s Rights Media Activism Women/Gender Youth Environmental Concerns Other What countries are you interested in learning about/organizing around? Argentina Bolivia Brazil Chile Colombia Cuba Ecuador El Salvador Guatemala Haiti Honduras Mexico Nicaragua Venezuela Other What experience/skills would you like to contribute to PCASC? Accounting Advertising/Media Databasing Grantwriting Graphic Design/Layout Office Work Translating Web Design Other What experience/skills would you like to learn from PCASC? Accounting Advertising/Media Databasing Grantwriting Graphic Design/Layout Office Work Translating Web Design Other How many hours a month do you or would you like to volunteer for PCASC? 1-5 5-10 10-20 More than 20 (clear) When are you available to volunteer? Monday Daytime Monday Evening Tuesday Daytime Tuesday Evening Wednesday Daytime Wednesday Evening Thursday Daytime Thursday Evening Friday Daytime Friday Evening Saturday Daytime Saturday Evening Sunday Daytime Sunday Evening Please check off which Committees you are involved with/interested in getting involved with Bolivarian Media Exchange El Salvador/CISPES Committee Hands Off Latin America (HOLA) Safe Communities [Immigrant Rights Campaign] I don’t Know/I want to be a general volunteer Would you be interested in attending a new volunteer orientation? Yes No (clear)
