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First Name *

Last Name *

Email *

Your Twitter username?

Organizational affiliation?

Organization/Personal Link?

Your organization's Twitter username?

Logo URL?

Please provide a direct image download link, not a press kit web page.

How would you like to be listed?

Name only (signing as an individual)

Name + Title (signing as an individual)

Organization only (signing as an organization)

Sign on as organization and myself as an individual

Anonymously

Would you like us to keep you updated?

Yes

No

Would you like to help more?

I can help with outreach to Signatories.

I can help write letters, emails, or website copy.

I can help with outreach to Congress.

Other help I can offer

Please describe

Any other comments you want to share