Southern National Congress Volunteer Sign-Up Form
All personal and contact information shared with the SNC Committee on this site will be held in 
strictest confidence and used only for the stated purposes of organizing and supporting the SNC.

General Information:

Name:  Mr. Mrs. Miss Dr. Rev. Pastor    First       Last

Mailing Address:  Street 

City or Town:   State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   Zip Code:

Email:

Phone:

Qualification:

Are you at least 18 years of age?  Yes  No

Do you warrant that you are of good moral character, have no criminal record, and have never been convicted of a mal in se crime; that is, a thing “evil in itself,” (murder, rape, arson, kidnapping, violent assault, armed robbery, etc.)  Yes

 I have read and understand the Southern National Congress statement on qualifications for Participation  Yes

Participation Interests (please check all that apply):

I desire to be a Southern National Congress Delegate.
I would like to assist with recruitment duties.
I would like to assist with fund raising programs.
I would like to assist with organizing duties.
I would like to assist with public relations and information.

Please tell us about any talents, skills, previous experience, or educational attainment that you believe would be an asset for the Southern National Congress. You may also include any comments you wish to make: