Mobilization for Health Care for All

Thanks for stepping up to join the battle!

We need some information to help organize an action with others in your area.

Note: You will not be signed up to do civil disobedience or legal protest until you have filled out the form below and checked "I will risk arrest in a nonviolent sit-in" or "I cannot risk arrest, but will do legal protest in support of a sit-in".

First Name*

Last Name*

Email*

Phone*

Zip/Postal Code*

Organization

I will risk arrest in a nonviolent sit-in

I cannot risk arrest, but will do legal protest in support of a sit-in

I have been arrested in a nonviolent civil disobedience action before

I can provide nonviolence training

I am a lawyer

I am currently being denied care, approval, coverage (due to rescission) for a serious condition by my insurance company

Someone in my family is being denied care, approval, coverage (due to rescission) for a serious condition by their/our insurance company

What insurance company?