Tuesday, November 11, 2014

Registration 5/21/17



Registration Form for Coordination
A Civic People of Baton Rouge
Establish We the Civic People of the United States
for June 21, 2017
Name:  ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­__________________________________________________________________
Address:  ­­­­­­­­­­­­­­­­­­________________________________________________________________
E-Mail Address:   _______________________   Affiliation: _________
Phone numbers cell:   _____________________     Land phone: ____________
If Student/Faculty, circle:   Student    Faculty    School______________   
How did you learn about the meeting? (circle any):  Blog     Radio   Friend  Flyer            Invitation        Newspaper      Library       Presenter
What motivates you to participate? ­­­­­___________________________________­­­­­­­­­­­­­­­­­_________________________
How would you paraphrase the preamble to the US Constitution?

Which of the nine civic goals would you consider/discuss--in a future meeting to consider needs for 2017? (circle one): establish justice          form a more perfect Union         insure domestic Tranquility   provide for the common defense       promote the general Welfare            secure the Blessings of Liberty to ourselves             secure the Blessings of Liberty to our Posterity    refine the Constitution         promote domestic goodwill
Concerns regarding civic safety and security:  ________________________________________
 ______________________________________________________________
Skills and resources you may offer:  ­­­____________________________________________
 ______________________________________________________________
Please scan, complete as much as you wish and email to philrbeaver@gmail.com , or mail to
Phil Beaver, 1624 Leycester Drive, Baton Rouge, LA 70808