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    Ways to Volunteer: Activist Participation Form

    Grassroots advocacy is our democracy's foundation. As taxpaying citizens, we have a constitutional right - and a responsibility - to speak out about our government. Elected officials can't respond to our concerns unless we communicate our needs. Working together as citizens, we have the power to help enact laws that will make a difference.

    As an Activist , for the National Committee, your work is essential to our efforts to preserve and strengthen Social Security, Medicare and other programs which serve our seniors and families. 

    Are you interested in protecting your Social Security and Medicare benefits by participating in our Grassroots Team activities? Please take a few minutes to complete the form below. We look forward to partnering with you on this effort.

       
    First Name:
    Last Name:
    Email:
    Address:
    City:
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    Phone Number: - -
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    I want to: Attend Meetings
      Distribute Literature
      Make Phone Calls
      Meet Lawmakers
      Organize Meetings
      Write Letters
       
    I heard about NCPSSM via: Radio (What Station?)
      Newspaper
      Televison (what station?)
      Friend
      Townhall Meeting
      Mailing
      Other:
       
    Check One: (optional) Black/African American
      American Indian
      White
      Hispanic/Latino
      Asian/Pacific Islander
      Other:
       
    Birth Year: