March on Burger King, “Our World, Our Rights” Conference & Housing in Miami

Registration for March on Burger King, “Our World, Our Rights” Conference & Housing in Miami.

1. CONTACT INFORMATION:

(Please fill out the following sections that apply to you or your group. Asterisks indicate required fields.)

Title:

First name:*

Last name:*

Group/Organization/Affiliation:*

Street address:*

City:*

State:*

Zip:*

Email:*

Phone:*

Total # in your group:*

Please list names of everyone in your group (separate with commas):*

If more than 10, we will contact you for a complete list.

2. MARCH ON BURGER KING:

Total # in your group:

I/we plan to join the CIW for:
Entire march (9 miles, beginning 9:00 am)
1/2 the march (4 miles, beginning at 1:00 pm)
Final mile (3:00 pm)

I/we will join the CIW for the 3:30 pm rally at Burger King’s corporate headquarters:
Yes
No

Lunch (for participants marching the full 9-mile route only):
Please include me/us in the lunch count (donations encouraged, no one turned away)
I/we will bring my/our own lunch

Optional: I am/we are interested in volunteering during the march (please check one):
Security
Water and meal distribution
Art and animation
Flyering
Other

I/we understand that the CIW is committed to non-violent social change:
I/we will respect their leadership throughout the duration of the action.

Special needs (please list):

3. “Our World, Our Rights” Conference & Concert for Fair Food:

Total # in your group:

I/we plan to attend::
“Our World, Our Rights” Conference
Concert for Fair Food
Both the conference and concert

Please include me in the lunch count (donations encouraged, no one turned away):
Yes
No

I/we would like to reserve an information table for my/our group:
Yes
No

I am/we are interested in leading a workshop or panel discussion (please list topic):

Special needs (please list):

4. Housing in Miami:

Please note: the CIW is working with Miami-area congregations to secure free floor space for statewide and national allies.

Total # in your group:

Arrival date & time (please list):

Departure date & time (please list):

I/we need housing on (check all that apply):
Thursday night, Nov. 29
Friday night, Nov. 30
Saturday night, Dec. 1

Transportation:
I/we will have my/our own vehicle while in Miami
I/we need transportation assistance while in Miami
I/we would like to be picked up/dropped off at the airport

I am/we are interested in sharing meals with CIW and allies (donations required) for the following meals (check all that apply):
Breakfast on Friday, 11/30
Lunch on Friday, 11/30
Dinner on Friday, 11/30
Breakfast on Saturday, 12/1
Lunch on Saturday, 12/1
Dinner on Saturday, 12/1
Breakfast on Sunday, 12/2

I/we will provide my/our own food:
Yes
No

Special needs for meals or housing (please list):

(For example, if you are unable to sleep on the floor, please indicate this here.)

I/we agree to follow the CIW’s leadership and respect the rules of the host congregation:
Yes, I/we agree.

I/we will not use drugs or alcohol during the two-day mobilization:
Yes, I/we agree.

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March on Burger King, “Our World, Our Rights” Conference & Housing in Miami