Wanderlust Involvement Questionnaire

Thanks for your interest in being involved in Wanderlust. Please take a moment to complete the questions on this form, and the Trip Coordinator will be in touch with you very soon. If you have any questions, please email wanderlust@protectchoice.org.

1. HOSTS
Please tell us how you're interested in participating in Wanderlust by checking all boxes that apply. Required Question

	I can host the riders overnight
	I'd like the riders to meet with me and/or my organization
	I can host a meeting or discussion with the riders
	I have a recommendation for someone you should talk to

2. ORGANIZATIONAL INFORMATION
Please tell us a little bit about the work you do.

3. RECOMMENDATIONS
Do you know of organizations or individuals doing interesting work in reproductive justice along the route? Please fill in all the information you know about the group.

If YOU are a person who would like to meet with us, skip this section and fill out your contact info in Question 6

Organization

Contact Name

Title

Area of Focus

Street Address

Apt/Suite/Office

City

State

Postal Code

Email Address

Phone Number

URL

4. LOCATION
Please indicate your city or town. If your city is not listed, please fill in the box below. This route is subject to change, so we may not visit all the cities on this list, and we may visit some that are not listed.

If your organization is in more than one location, please use the control key to select more than one city.

5. OTHER PLACES
If your location is not listed in the drop down menu above, please enter it here.

6. CONTACT INFORMATION
Please provide your contact information.

First Name Required Question

Last Name