www.ofwaction.com
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198.49.23.144
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Submitted URL: http://raisethewageaz.org/
Effective URL: https://www.ofwaction.com/arizona
Submission: On July 03 via api from US — Scanned from DE
Effective URL: https://www.ofwaction.com/arizona
Submission: On July 03 via api from US — Scanned from DE
Form analysis 2 forms found in the DOM
POST
<form class="clearfix" method="post" novalidate="" action="" accept-charset="utf-8" autocomplete="on">
<div data-name="undefined" data-subview="submit_view" data-subview-index="1"></div>
<fieldset class="at-fieldset ContactInformation" id="NVSignupForm1428411-ContactInformation">
<legend class="at-legend">Contact Information</legend>
<div class="at-fields">
<div class="at-row FirstName LastName"><label class="at-text FirstName" id="NVSignupForm1428411-ContactInformation-FirstName">First Name<input type="text" autocomplete="given-name" x-autocompletetype="given-name" required=""
title="First Name (required)" name="FirstName" value="" maxlength="20">
</label><label class="at-text LastName" id="NVSignupForm1428411-ContactInformation-LastName">Last Name<input type="text" autocomplete="family-name" x-autocompletetype="surname" required="" title="Last Name (required)" name="LastName"
value="" maxlength="25">
</label></div>
<div class="at-row PreferredLanguages Pronoun"><label class="at-select PreferredLanguages multi-select" id="NVSignupForm1428411-ContactInformation-PreferredLanguages">Preferred Language<select multiple="" required="" autocomplete="on"
title="Preferred Language" name="PreferredLanguages" class="required select2-hidden-accessible" id="NVSignupForm1428411-ContactInformation-PreferredLanguages-select" tabindex="-1" aria-hidden="true">
<option value="" disabled="">- Select -</option>
<option value="62">Amharic</option>
<option value="63">Arabic</option>
<option value="22">Armenian</option>
<option value="111">ASL</option>
<option value="1">Bengali</option>
<option value="72">Bhutanese</option>
<option value="68">Bosnian</option>
<option value="42">Bulgarian</option>
<option value="43">Burmese</option>
<option value="2">Cantonese</option>
<option value="73">Chamorro</option>
<option value="69">Creole</option>
<option value="64">Croatian</option>
<option value="116">Czech</option>
<option value="60">Danish</option>
<option value="37">Dutch</option>
<option value="3">English</option>
<option value="45">Estonian</option>
<option value="121">Filipino</option>
<option value="47">Finnish</option>
<option value="4">French</option>
<option value="26">German</option>
<option value="38">Greek</option>
<option value="5">Gujarati</option>
<option value="50">Hebrew</option>
<option value="6">Hindi</option>
<option value="67">Hmong</option>
<option value="39">Hungarian</option>
<option value="48">Icelandic</option>
<option value="74">Ilocano</option>
<option value="49">Indonesian</option>
<option value="28">Italian</option>
<option value="119">Iu Mien</option>
<option value="7">Japanese</option>
<option value="80">Kannada</option>
<option value="75">Karenni</option>
<option value="113">Khmer</option>
<option value="8">Korean</option>
<option value="51">Lao</option>
<option value="52">Latvian</option>
<option value="53">Lithuanian</option>
<option value="88">Malay</option>
<option value="9">Malayalam</option>
<option value="10">Mandarin</option>
<option value="81">Marathi</option>
<option value="11">Nepali</option>
<option value="36">Norwegian</option>
<option value="112">Not Listed</option>
<option value="30">Polish</option>
<option value="55">Portuguese</option>
<option value="12">Punjabi</option>
<option value="13">Russian</option>
<option value="32">Samoan</option>
<option value="70">Serbian</option>
<option value="115">Simplified Chinese</option>
<option value="120">Sinhala</option>
<option value="123">Slovak</option>
<option value="65">Somali</option>
<option value="15">Spanish</option>
<option value="78">Swahili</option>
<option value="31">Swedish</option>
<option value="16">Tagalog</option>
<option value="17">Tamil</option>
<option value="57">Thai</option>
<option value="18">Tibetan</option>
<option value="66">Tigrinya</option>
<option value="79">Tokelauan</option>
<option value="122">Traditional Chinese</option>
<option value="58">Turkish</option>
<option value="71">Ukranian</option>
<option value="19">Urdu</option>
<option value="20">Vietnamese</option>
</select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: 425px;"><span class="selection"><span class="select2-selection select2-selection--multiple" role="combobox" aria-haspopup="true"
aria-expanded="false" title="Preferred Language" tabindex="-1">
<ul class="select2-selection__rendered">
<li class="select2-search select2-search--inline"><input class="select2-search__field" type="search" tabindex="0" autocomplete="off" autocorrect="off" autocapitalize="off" spellcheck="false" role="textbox" aria-autocomplete="list"
placeholder="- Select -" style="width: 423px;"></li>
</ul>
</span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
</label><label class="at-select Pronoun" id="NVSignupForm1428411-ContactInformation-Pronoun">Pronouns<select required="" autocomplete="on" title="Pronouns" name="Pronoun" class=" required"
id="NVSignupForm1428411-ContactInformation-Pronoun-select">
<option value="" disabled="">- Select -</option>
<option value="5">(F)ae/(F)aer/(F)aers</option>
<option value="19">Any/All Pronouns</option>
<option value="6">E/Em/Eirs</option>
<option value="7">Ey/Em/Eirs</option>
<option value="2">He/Him/His</option>
<option value="18">He/She/They</option>
<option value="16">He/Them/Theirs</option>
<option value="17">Name Only</option>
<option value="8">Per/Per/Pers</option>
<option value="1">She/Her/Hers</option>
<option value="15">She/Them/Theirs</option>
<option value="9">Sie/Sie/Hirs</option>
<option value="10">Tey/Ter/Ters</option>
<option value="3">They/Them/Theirs</option>
<option value="11">Ve/Ver/Vers</option>
<option value="12">Ve/Ver/Vis</option>
<option value="4">Xe/Xem/Xyrs</option>
<option value="13">Ze/Hir/Hirs</option>
<option value="14">Zie/Zim/Zis</option>
</select>
</label></div>
<div class="at-row Genders SexualOrientation Race Ethnicity"><label class="at-select Genders multi-select" id="NVSignupForm1428411-ContactInformation-Genders">Gender<select multiple="" required="" autocomplete="on" title="Gender" name="Genders"
class="required select2-hidden-accessible" id="NVSignupForm1428411-ContactInformation-Genders-select" tabindex="-1" aria-hidden="true">
<option value="" disabled="">- Select -</option>
<option value="18">Agender</option>
<option value="1">Androgynous</option>
<option value="20">Bigender</option>
<option value="21">Butch</option>
<option value="59">Cisgender Female</option>
<option value="58">Cisgender Male</option>
<option value="2">Female</option>
<option value="22">Femme</option>
<option value="4">FTM</option>
<option value="5">Gender Fluid</option>
<option value="6">Gender Non-conforming</option>
<option value="23">Gender Questioning</option>
<option value="24">Gender Variant</option>
<option value="25">Genderless</option>
<option value="7">Genderqueer</option>
<option value="27">Intersex</option>
<option value="8">Male</option>
<option value="28">Masc</option>
<option value="11">MTF</option>
<option value="29">Neither</option>
<option value="30">Neutrois</option>
<option value="12">Non-Binary</option>
<option value="31">Non-Op</option>
<option value="56">Not Listed</option>
<option value="33">Pangender</option>
<option value="34">Polygender</option>
<option value="13">Prefer Not to Say</option>
<option value="35">Queer</option>
<option value="14">Questioning</option>
<option value="57">Third Gender</option>
<option value="36">Transfeminine</option>
<option value="16">Transgender</option>
<option value="37">Transgender Female</option>
<option value="38">Transgender Male</option>
<option value="40">Transgender Person</option>
<option value="42">Transmasculine</option>
<option value="49">Two Spirit</option>
</select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: 203px;"><span class="selection"><span class="select2-selection select2-selection--multiple" role="combobox" aria-haspopup="true"
aria-expanded="false" title="Gender" tabindex="-1">
<ul class="select2-selection__rendered">
<li class="select2-search select2-search--inline"><input class="select2-search__field" type="search" tabindex="0" autocomplete="off" autocorrect="off" autocapitalize="off" spellcheck="false" role="textbox" aria-autocomplete="list"
placeholder="- Select -" style="width: 201px;"></li>
</ul>
</span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
</label><label class="at-select SexualOrientation multi-select" id="NVSignupForm1428411-ContactInformation-SexualOrientation">Sexual Orientation<select multiple="" required="" autocomplete="on" title="Sexual Orientation"
name="SexualOrientation" class="required select2-hidden-accessible" id="NVSignupForm1428411-ContactInformation-SexualOrientation-select" tabindex="-1" aria-hidden="true">
<option value="" disabled="">- Select -</option>
<option value="3">Asexual</option>
<option value="5">Bisexual</option>
<option value="6">Demisexual</option>
<option value="21">Gay</option>
<option value="9">Heterosexual</option>
<option value="22">Lesbian</option>
<option value="25">Not Listed</option>
<option value="14">Pansexual/Omnisexual</option>
<option value="18">Prefer not to Say</option>
<option value="16">Queer</option>
</select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: 203px;"><span class="selection"><span class="select2-selection select2-selection--multiple" role="combobox" aria-haspopup="true"
aria-expanded="false" title="Sexual Orientation" tabindex="-1">
<ul class="select2-selection__rendered">
<li class="select2-search select2-search--inline"><input class="select2-search__field" type="search" tabindex="0" autocomplete="off" autocorrect="off" autocapitalize="off" spellcheck="false" role="textbox" aria-autocomplete="list"
placeholder="- Select -" style="width: 201px;"></li>
</ul>
</span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
</label><label class="at-select Race multi-select" id="NVSignupForm1428411-ContactInformation-Race">Race<select multiple="" required="" autocomplete="on" title="Race" name="Race" class="required select2-hidden-accessible"
id="NVSignupForm1428411-ContactInformation-Race-select" tabindex="-1" aria-hidden="true">
<option value="" disabled="">- Select -</option>
<option value="26">Asian or Asian American</option>
<option value="2">Black or African American</option>
<option value="10">Hispanic</option>
<option value="12">Middle Eastern</option>
<option value="17">Multi-racial</option>
<option value="4">Native American</option>
<option value="5">Native Hawaiian</option>
<option value="25">Not Listed</option>
<option value="7">Pacific Islander</option>
<option value="27">White</option>
</select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: 203px;"><span class="selection"><span class="select2-selection select2-selection--multiple" role="combobox" aria-haspopup="true"
aria-expanded="false" title="Race" tabindex="-1">
<ul class="select2-selection__rendered">
<li class="select2-search select2-search--inline"><input class="select2-search__field" type="search" tabindex="0" autocomplete="off" autocorrect="off" autocapitalize="off" spellcheck="false" role="textbox" aria-autocomplete="list"
placeholder="- Select -" style="width: 201px;"></li>
</ul>
</span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
</label><label class="at-select Ethnicity multi-select" id="NVSignupForm1428411-ContactInformation-Ethnicity">Ethnicity<select multiple="" required="" autocomplete="on" title="Ethnicity" name="Ethnicity"
class="required select2-hidden-accessible" id="NVSignupForm1428411-ContactInformation-Ethnicity-select" tabindex="-1" aria-hidden="true">
<option value="" disabled="">- Select -</option>
<option value="1">Afghani</option>
<option value="78">African American</option>
<option value="2">Arab</option>
<option value="21">Arabian</option>
<option value="22">Armenian</option>
<option value="4">Bangladeshi</option>
<option value="97">Bengali</option>
<option value="5">Bhutanese</option>
<option value="6">Brazilian</option>
<option value="54">Bulgarian</option>
<option value="55">Burmese</option>
<option value="56">Cambodian</option>
<option value="93">Chamorro</option>
<option value="98">Chin</option>
<option value="7">Chinese</option>
<option value="44">Czechoslovakian</option>
<option value="75">Danish</option>
<option value="46">Dutch</option>
<option value="8">East African</option>
<option value="88">Egyptian</option>
<option value="26">English (British)</option>
<option value="57">Estonian</option>
<option value="58">Ethiopian</option>
<option value="9">Filipino</option>
<option value="59">Finnish</option>
<option value="27">French</option>
<option value="28">German</option>
<option value="47">Greek</option>
<option value="10">Haitian</option>
<option value="77">Hawaiian</option>
<option value="82">Hispanic</option>
<option value="11">Hmong</option>
<option value="48">Hungarian</option>
<option value="60">Icelandic</option>
<option value="25">Indian</option>
<option value="12">Indo Carribean</option>
<option value="61">Indonesian</option>
<option value="125">Iranian</option>
<option value="30">Irish</option>
<option value="31">Italian</option>
<option value="32">Japanese</option>
<option value="99">Karen</option>
<option value="40">Korean</option>
<option value="13">Lao</option>
<option value="20">Latino</option>
<option value="64">Latvian</option>
<option value="90">Lebanese</option>
<option value="65">Lithuanian</option>
<option value="66">Malaysian</option>
<option value="67">Manx</option>
<option value="96">Mien</option>
<option value="83">Mixed Ethnicity</option>
<option value="101">Mongolian</option>
<option value="89">Morrocan</option>
<option value="138">Native Alaskan</option>
<option value="35">Native American</option>
<option value="14">Nepali</option>
<option value="84">Non-Hispanic White</option>
<option value="45">Norwegian</option>
<option value="136">Not Listed</option>
<option value="103">Okinawan</option>
<option value="143">Pacific Islander</option>
<option value="15">Pakistani</option>
<option value="86">Persian</option>
<option value="34">Polish</option>
<option value="68">Portuguese</option>
<option value="50">Russian</option>
<option value="39">Samoan</option>
<option value="36">Scottish</option>
<option value="104">Singaporean</option>
<option value="16">Somali</option>
<option value="17">Sri Lankan</option>
<option value="37">Swedish</option>
<option value="71">Swiss</option>
<option value="137">Tagalog</option>
<option value="105">Taiwanese</option>
<option value="72">Thai</option>
<option value="18">Tibetan</option>
<option value="106">Tongan</option>
<option value="73">Turkish</option>
<option value="51">Ukrainian</option>
<option value="120">Unknown</option>
<option value="19">Vietnamese</option>
<option value="52">Welsh</option>
<option value="87">Yemeni</option>
<option value="74">Yugoslavian</option>
</select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: 203px;"><span class="selection"><span class="select2-selection select2-selection--multiple" role="combobox" aria-haspopup="true"
aria-expanded="false" title="Ethnicity" tabindex="-1">
<ul class="select2-selection__rendered">
<li class="select2-search select2-search--inline"><input class="select2-search__field" type="search" tabindex="0" autocomplete="off" autocorrect="off" autocapitalize="off" spellcheck="false" role="textbox" aria-autocomplete="list"
placeholder="- Select -" style="width: 201px;"></li>
</ul>
</span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
</label></div>
<div class="at-row at-row-solo AddressLine1"><label class="at-text AddressLine1" id="NVSignupForm1428411-ContactInformation-AddressLine1">Street Address<input type="text" autocomplete="address-line1" x-autocompletetype="address-line1"
required="" title="Street Address (required)" name="AddressLine1" value="" maxlength="99">
</label></div>
<div class="at-row PostalCode City StateProvince"><label class="at-text PostalCode" id="NVSignupForm1428411-ContactInformation-PostalCode">Postal Code<input type="tel" autocomplete="postal-code" x-autocompletetype="postal-code"
pattern="^\d{5}([\-]\d{4})?$" required="" title="Postal Code (required)" name="PostalCode" value="" maxlength="10">
</label><label class="at-text City" id="NVSignupForm1428411-ContactInformation-City">City<input type="text" autocomplete="address-level2" x-autocompletetype="locality" required="" title="City (required)" name="City" value="" maxlength="25">
</label><label class="at-select StateProvince" id="NVSignupForm1428411-ContactInformation-StateProvince">State/Province<select required="" autocomplete="address-level1" x-autocompletetype="administrative-area" title="State/Province"
name="StateProvince" class=" required" id="NVSignupForm1428411-ContactInformation-StateProvince-select">
<option value="" disabled="">- State -</option>
<option value="AK">AK</option>
<option value="AL">AL</option>
<option value="AR">AR</option>
<option value="AZ">AZ</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DC">DC</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="GA">GA</option>
<option value="HI">HI</option>
<option value="IA">IA</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="MA">MA</option>
<option value="MD">MD</option>
<option value="ME">ME</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MO">MO</option>
<option value="MS">MS</option>
<option value="MT">MT</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="NE">NE</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NV">NV</option>
<option value="NY">NY</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VA">VA</option>
<option value="VT">VT</option>
<option value="WA">WA</option>
<option value="WI">WI</option>
<option value="WV">WV</option>
<option value="WY">WY</option>
<option value="AS">AS</option>
<option value="FM">FM</option>
<option value="GU">GU</option>
<option value="MH">MH</option>
<option value="MP">MP</option>
<option value="PR">PR</option>
<option value="PW">PW</option>
<option value="VI">VI</option>
<option value="AA">AA</option>
<option value="AE">AE</option>
<option value="AP">AP</option>
</select>
</label></div>
<div class="at-row EmailAddress HomePhone MobilePhone"><label class="at-text EmailAddress" id="NVSignupForm1428411-ContactInformation-EmailAddress">Email<input type="email" autocomplete="email" x-autocompletetype="email"
pattern="^([\w!#$%&'*+\-\/=?\^`\{\|\}~]+\.)*[\w!#$%&'*+\-\/=?\^`\{\|\}~]+@((((([a-zA-Z0-9]{1}[a-zA-Z0-9\-]{0,62}[a-zA-Z0-9]{1})|[a-zA-Z])\.)+[a-zA-Z]{2,62})|(\d{1,3}\.){3}\d{1,3}(:\d{1,5})?)$" required="" title="Email (required)"
name="EmailAddress" value="" maxlength="100" placeholder="email@email.com">
</label><label class="at-text HomePhone" id="NVSignupForm1428411-ContactInformation-HomePhone">Home Phone<div class="intl-tel-input iti iti--allow-dropdown">
<div class="iti__flag-container">
<div class="iti__selected-flag" role="combobox" aria-controls="iti-0__country-listbox" aria-owns="iti-0__country-listbox" aria-expanded="false" tabindex="0" title="United States: +1" aria-activedescendant="iti-0__item-us-preferred">
<div class="iti__flag iti__us"></div>
<div class="iti__arrow"></div>
</div>
</div><input type="tel" class="intl-phone-HomePhone" name="HomePhone" title="Home Phone (required)" data-intl-tel-input-id="0">
</div>
</label><label class="at-text MobilePhone" id="NVSignupForm1428411-ContactInformation-MobilePhone">Mobile Phone<div class="intl-tel-input iti iti--allow-dropdown">
<div class="iti__flag-container">
<div class="iti__selected-flag" role="combobox" aria-controls="iti-1__country-listbox" aria-owns="iti-1__country-listbox" aria-expanded="false" tabindex="0" title="United States: +1" aria-activedescendant="iti-1__item-us-preferred">
<div class="iti__flag iti__us"></div>
<div class="iti__arrow"></div>
</div>
</div><input type="tel" class="intl-phone-MobilePhone" name="MobilePhone" title="Mobile Phone (required)" data-intl-tel-input-id="1">
</div>
</label></div>
<div class="at-row at-row-solo SmsSubscribeMobilePhone"><input id="SmsSubscribeMobilePhone_Value" type="hidden" name="SmsSubscribeMobilePhone.Value" value="true"></div>
<div class="at-row at-row-solo at-row-full SmsLegalDisclaimer">
<div class="at-markup SmsLegalDisclaimer at-legal" id="NVSignupForm1428411-ContactInformation-SmsLegalDisclaimer">
<p>By submitting your cell phone number you are agreeing to receive periodic text messages from this organization. Message and data rates may apply. Text HELP for more information. Text STOP to stop receiving messages.</p>
</div>
</div>
<div class="at-row at-row-solo YesSignMeUpForUpdatesForBinder"><input id="YesSignMeUpForUpdatesForBinder_Value" type="hidden" name="YesSignMeUpForUpdatesForBinder.Value" value="true"></div>
<div class="at-row "><label class="at-text PersonalUrl" id="NVSignupForm1428411-ContactInformation-PersonalUrl"> <small>(Optional)</small><input type="text" autocomplete="on" false="" title="" name="PersonalUrl" value="" maxlength="">
</label></div>
<div class="at-row ">
<div class="at-markup TrackingPixel" id="NVSignupForm1428411-ContactInformation-TrackingPixel" style="display: none;"><img alt=""
src="https://secure.everyaction.com/v1/Track/gmbn5t9pyUqoa1mYY1vjYQ2?formSessionId=8fed0fa1-b058-487e-b47a-fc4c40640f88&bName=chrome&dType=desktop&formVersion=11/5/2022 4:37:33 AM|&fUrl=aHR0cHM6Ly93d3cub2Z3YWN0aW9uLmNvbS9hcml6b25h&fRef="
style="display:none"></div>
</div>
</div>
</fieldset>
<fieldset class="at-fieldset AdditionalInformation" id="NVSignupForm1428411-AdditionalInformation">
<legend class="at-legend">Additional Information</legend>
<div class="at-fields">
<div class="at-row at-row-full CustomFormFieldQuestion_5902446143475565">
<div id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_5902446143475565"><label name="CustomFormFieldQuestion_5902446143475565" class="checkbox-list-label"> Which area are you closest to (check all that apply): <br>
<small class="checkbox-list-required-text" name="CustomFormFieldQuestion_5902446143475565-small" style="display: none"><b>Which area are you closest to (check all that apply): is required.</b></small>
</label>
</div>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_139033308460821">
<label class="at-check CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_139033308460821" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_139033308460821"><input
type="checkbox" name="CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_139033308460821" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_5902446143475565"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_139033308460821-label">Central Phoenix</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_8976595842507185">
<label class="at-check CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_8976595842507185" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_8976595842507185"><input
type="checkbox" name="CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_8976595842507185" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_5902446143475565"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_8976595842507185-label">North Central Phoenix</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_6969642301029595">
<label class="at-check CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_6969642301029595" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_6969642301029595"><input
type="checkbox" name="CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_6969642301029595" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_5902446143475565"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_6969642301029595-label">South Phoenix</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_4496707690925029">
<label class="at-check CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_4496707690925029" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_4496707690925029"><input
type="checkbox" name="CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_4496707690925029" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_5902446143475565"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_4496707690925029-label">West Phoenix</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_7224758928639253">
<label class="at-check CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_7224758928639253" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_7224758928639253"><input
type="checkbox" name="CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_7224758928639253" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_5902446143475565"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_7224758928639253-label">Mesa/Tempe</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_2102205899801495">
<label class="at-check CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_2102205899801495" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_2102205899801495"><input
type="checkbox" name="CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_2102205899801495" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_5902446143475565"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_5902446143475565_CustomFormFieldQuestion_2102205899801495-label">Tucson</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_8377829717201251_MappedCustomFormFieldQuestion_356">
<label class="at-select CustomFormFieldQuestion_8377829717201251_MappedCustomFormFieldQuestion_356" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_8377829717201251_MappedCustomFormFieldQuestion_356">Which state do you
work in?<select required="" autocomplete="on" title="Which state do you work in?" name="CustomFormFieldQuestion_8377829717201251_MappedCustomFormFieldQuestion_356" class=" required"
id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_8377829717201251_MappedCustomFormFieldQuestion_356-select">
<option value="" disabled="">- Select -</option>
<option value="8">AK</option>
<option value="9">AL</option>
<option value="10">AR</option>
<option value="11">AS</option>
<option value="12">AZ</option>
<option value="13">CA</option>
<option value="14">CO</option>
<option value="15">CT</option>
<option value="16">DC</option>
<option value="17">DE</option>
<option value="18">FL</option>
<option value="19">GA</option>
<option value="20">GU</option>
<option value="21">HI</option>
<option value="22">IA</option>
<option value="23">ID</option>
<option value="24">IL</option>
<option value="25">IN</option>
<option value="26">KS</option>
<option value="27">KY</option>
<option value="28">LA</option>
<option value="29">MA</option>
<option value="30">MD</option>
<option value="31">ME</option>
<option value="32">MI</option>
<option value="33">MN</option>
<option value="34">MO</option>
<option value="35">MP</option>
<option value="36">MS</option>
<option value="37">MT</option>
<option value="38">NC</option>
<option value="39">ND</option>
<option value="40">NE</option>
<option value="41">NH</option>
<option value="42">NJ</option>
<option value="43">NM</option>
<option value="44">NV</option>
<option value="45">NY</option>
<option value="46">OH</option>
<option value="47">OK</option>
<option value="48">OR</option>
<option value="49">PA</option>
<option value="50">PR</option>
<option value="51">RI</option>
<option value="52">SC</option>
<option value="53">SD</option>
<option value="54">TN</option>
<option value="55">TX</option>
<option value="56">UT</option>
<option value="57">VA</option>
<option value="58">VI</option>
<option value="59">VT</option>
<option value="60">WA</option>
<option value="61">WI</option>
<option value="62">WV</option>
<option value="63">WY</option>
</select>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_3507996753274751_MappedCustomFormFieldQuestion_355">
<label class="at-text CustomFormFieldQuestion_3507996753274751_MappedCustomFormFieldQuestion_355" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_3507996753274751_MappedCustomFormFieldQuestion_355">Can you tell us the
name of the establishment where you work currently or most recently worked?<input type="text" autocomplete="on" required="" title="Can you tell us the name of the establishment where you work currently or most recently worked? (required)"
name="CustomFormFieldQuestion_3507996753274751_MappedCustomFormFieldQuestion_355" value="" maxlength="75">
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_5728355553562881_MappedSurveyQuestion_462218">
<label class="at-select CustomFormFieldQuestion_5728355553562881_MappedSurveyQuestion_462218" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_5728355553562881_MappedSurveyQuestion_462218">Which best describes the
establishment where you work(ed)?<select required="" autocomplete="on" title="Which best describes the establishment where you work(ed)?" name="CustomFormFieldQuestion_5728355553562881_MappedSurveyQuestion_462218" class=" required"
id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_5728355553562881_MappedSurveyQuestion_462218-select">
<option value="" disabled="">- Select -</option>
<option value="1882998">Casual, full service</option>
<option value="1882999">Fast Food</option>
<option value="1883000">Fine-dining</option>
<option value="1883004">Other tipped</option>
</select>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_2808662164396339_MappedSurveyQuestion_462213">
<label class="at-select CustomFormFieldQuestion_2808662164396339_MappedSurveyQuestion_462213" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_2808662164396339_MappedSurveyQuestion_462213">When were you last employed at
the above establishment?<select required="" autocomplete="on" title="When were you last employed at the above establishment?" name="CustomFormFieldQuestion_2808662164396339_MappedSurveyQuestion_462213" class=" required"
id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_2808662164396339_MappedSurveyQuestion_462213-select">
<option value="" disabled="">- Select -</option>
<option value="1882987">Currently employed</option>
<option value="1882988">Left before April 1 2021</option>
<option value="1882989">Left after April 1 2021</option>
</select>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_3847509603249315">
<div id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_3847509603249315"><label name="CustomFormFieldQuestion_3847509603249315" class="checkbox-list-label"> Are you willing to sign on to our petition for One Fair
Wage? <br>
<small class="checkbox-list-required-text" name="CustomFormFieldQuestion_3847509603249315-small" style="display: none"><b>Are you willing to sign on to our petition for One Fair Wage? is required.</b></small>
</label>
</div>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_3847509603249315_CustomFormFieldQuestion_1387182030751865">
<label class="at-check CustomFormFieldQuestion_3847509603249315_CustomFormFieldQuestion_1387182030751865" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_3847509603249315_CustomFormFieldQuestion_1387182030751865"><input
type="checkbox" name="CustomFormFieldQuestion_3847509603249315_CustomFormFieldQuestion_1387182030751865" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_3847509603249315"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_3847509603249315_CustomFormFieldQuestion_1387182030751865-label">Yes</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_3847509603249315_CustomFormFieldQuestion_5192908552851651">
<label class="at-check CustomFormFieldQuestion_3847509603249315_CustomFormFieldQuestion_5192908552851651" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_3847509603249315_CustomFormFieldQuestion_5192908552851651"><input
type="checkbox" name="CustomFormFieldQuestion_3847509603249315_CustomFormFieldQuestion_5192908552851651" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_3847509603249315"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_3847509603249315_CustomFormFieldQuestion_5192908552851651-label">No</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_2209274098249169_MappedCustomFormFieldQuestion_361">
<label class="at-text CustomFormFieldQuestion_2209274098249169_MappedCustomFormFieldQuestion_361" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_2209274098249169_MappedCustomFormFieldQuestion_361">What motivated you
to apply for the fund?<input type="text" autocomplete="on" required="" title="What motivated you to apply for the fund? (required)" name="CustomFormFieldQuestion_2209274098249169_MappedCustomFormFieldQuestion_361" value="" maxlength="75">
</label>
</div>
<div class="at-row at-row-full QuestionHtml_370311359">
<div class="at-markup QuestionHtml_370311359" id="NVSignupForm1428411-AdditionalInformation-QuestionHtml_370311359">
<p>You can view the text of the petition and sign it right now by <a href="https://secure.everyaction.com/mqXYJ9nN0EuWBs96cWPjcw2">clicking here</a>.</p>
</div>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_4490411195797349_MappedSurveyQuestion_382807">
<label class="at-select CustomFormFieldQuestion_4490411195797349_MappedSurveyQuestion_382807" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4490411195797349_MappedSurveyQuestion_382807">Are you interested in joining
with other current and former service workers to fight for a fair minimum wage for all workers, including tipped workers?<select required="" autocomplete="on"
title="Are you interested in joining with other current and former service workers to fight for a fair minimum wage for all workers, including tipped workers?" name="CustomFormFieldQuestion_4490411195797349_MappedSurveyQuestion_382807"
class=" required" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4490411195797349_MappedSurveyQuestion_382807-select">
<option value="" disabled="">- Select -</option>
<option value="1571376">Yes</option>
<option value="1571377">No</option>
<option value="1571378">Uncertain</option>
</select>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_6064732255364173">
<div id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_6064732255364173"><label name="CustomFormFieldQuestion_6064732255364173" class="checkbox-list-label"> Do you have children? <small>(Optional)</small><br>
<small class="checkbox-list-required-text" name="CustomFormFieldQuestion_6064732255364173-small" style="display: none"><b>Do you have children? is required.</b></small>
</label>
</div>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_6064732255364173_CustomFormFieldQuestion_7417538995703829">
<label class="at-check CustomFormFieldQuestion_6064732255364173_CustomFormFieldQuestion_7417538995703829" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_6064732255364173_CustomFormFieldQuestion_7417538995703829"><input
type="checkbox" name="CustomFormFieldQuestion_6064732255364173_CustomFormFieldQuestion_7417538995703829" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_6064732255364173"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_6064732255364173_CustomFormFieldQuestion_7417538995703829-label">Yes</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_6064732255364173_CustomFormFieldQuestion_5842976342024123">
<label class="at-check CustomFormFieldQuestion_6064732255364173_CustomFormFieldQuestion_5842976342024123" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_6064732255364173_CustomFormFieldQuestion_5842976342024123"><input
type="checkbox" name="CustomFormFieldQuestion_6064732255364173_CustomFormFieldQuestion_5842976342024123" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_6064732255364173"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_6064732255364173_CustomFormFieldQuestion_5842976342024123-label">No</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_6064732255364173_CustomFormFieldQuestion_7626596468414597">
<label class="at-check CustomFormFieldQuestion_6064732255364173_CustomFormFieldQuestion_7626596468414597" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_6064732255364173_CustomFormFieldQuestion_7626596468414597"><input
type="checkbox" name="CustomFormFieldQuestion_6064732255364173_CustomFormFieldQuestion_7626596468414597" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_6064732255364173"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_6064732255364173_CustomFormFieldQuestion_7626596468414597-label">Prefer not to answer</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_7602081606397349">
<div id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7602081606397349"><label name="CustomFormFieldQuestion_7602081606397349" class="checkbox-list-label"> How many dependents are you responsible
for? <small>(Optional)</small><br>
<small class="checkbox-list-required-text" name="CustomFormFieldQuestion_7602081606397349-small" style="display: none"><b>How many dependents are you responsible for? is required.</b></small>
</label>
</div>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_1605468433701299">
<label class="at-check CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_1605468433701299" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_1605468433701299"><input
type="checkbox" name="CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_1605468433701299" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7602081606397349"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_1605468433701299-label">0</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_8746100247994955">
<label class="at-check CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_8746100247994955" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_8746100247994955"><input
type="checkbox" name="CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_8746100247994955" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7602081606397349"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_8746100247994955-label">1</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_6712357066344253">
<label class="at-check CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_6712357066344253" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_6712357066344253"><input
type="checkbox" name="CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_6712357066344253" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7602081606397349"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_6712357066344253-label">2</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_4754783164133929">
<label class="at-check CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_4754783164133929" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_4754783164133929"><input
type="checkbox" name="CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_4754783164133929" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7602081606397349"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_4754783164133929-label">3</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_6148478872322051">
<label class="at-check CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_6148478872322051" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_6148478872322051"><input
type="checkbox" name="CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_6148478872322051" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7602081606397349"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_6148478872322051-label">4 or More</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_8368282721391415">
<label class="at-check CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_8368282721391415" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_8368282721391415"><input
type="checkbox" name="CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_8368282721391415" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7602081606397349"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7602081606397349_CustomFormFieldQuestion_8368282721391415-label">I Prefer Not To
Answer</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_3101886999018635_MappedSurveyQuestion_382906">
<label class="at-select CustomFormFieldQuestion_3101886999018635_MappedSurveyQuestion_382906" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_3101886999018635_MappedSurveyQuestion_382906">How many people live in your
household, including you? - as in children or other adults you support financially? <small>(Optional)</small><select autocomplete="on"
title="How many people live in your household, including you? - as in children or other adults you support financially?" name="CustomFormFieldQuestion_3101886999018635_MappedSurveyQuestion_382906" class=" "
id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_3101886999018635_MappedSurveyQuestion_382906-select">
<option value="">- Select -</option>
<option value="1571685">1</option>
<option value="1571686">2</option>
<option value="1571687">3</option>
<option value="1571688">4</option>
<option value="1571689">5</option>
<option value="1571690">6</option>
<option value="1571691">7</option>
<option value="1571692">8</option>
<option value="1571693">9</option>
<option value="1571694">10+</option>
</select>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_4146928715385839">
<div id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4146928715385839"><label name="CustomFormFieldQuestion_4146928715385839" class="checkbox-list-label"> Can you currently afford to make your next rent/mortgage
payment? <small>(Optional)</small><br>
<small class="checkbox-list-required-text" name="CustomFormFieldQuestion_4146928715385839-small" style="display: none"><b>Can you currently afford to make your next rent/mortgage payment? is required.</b></small>
</label>
</div>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_4146928715385839_CustomFormFieldQuestion_2701733535439553">
<label class="at-check CustomFormFieldQuestion_4146928715385839_CustomFormFieldQuestion_2701733535439553" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4146928715385839_CustomFormFieldQuestion_2701733535439553"><input
type="checkbox" name="CustomFormFieldQuestion_4146928715385839_CustomFormFieldQuestion_2701733535439553" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4146928715385839"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4146928715385839_CustomFormFieldQuestion_2701733535439553-label">Yes</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_4146928715385839_CustomFormFieldQuestion_8014259297566071">
<label class="at-check CustomFormFieldQuestion_4146928715385839_CustomFormFieldQuestion_8014259297566071" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4146928715385839_CustomFormFieldQuestion_8014259297566071"><input
type="checkbox" name="CustomFormFieldQuestion_4146928715385839_CustomFormFieldQuestion_8014259297566071" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4146928715385839"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4146928715385839_CustomFormFieldQuestion_8014259297566071-label">No</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_4146928715385839_CustomFormFieldQuestion_3144075160820925">
<label class="at-check CustomFormFieldQuestion_4146928715385839_CustomFormFieldQuestion_3144075160820925" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4146928715385839_CustomFormFieldQuestion_3144075160820925"><input
type="checkbox" name="CustomFormFieldQuestion_4146928715385839_CustomFormFieldQuestion_3144075160820925" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4146928715385839"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4146928715385839_CustomFormFieldQuestion_3144075160820925-label">Not Applicable</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_3350963508375097">
<label class="at-select CustomFormFieldQuestion_3350963508375097 multi-select" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_3350963508375097">Do you qualify for government benefits such as unemployment insurance?
<small>(Optional)</small><select multiple="" autocomplete="on" title="Do you qualify for government benefits such as unemployment insurance?" name="CustomFormFieldQuestion_3350963508375097" class="select2-hidden-accessible"
id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_3350963508375097-select" tabindex="-1" aria-hidden="true">
<option value="">- Select -</option>
<option value="3644350590536655">Yes</option>
<option value="172339198292871">No</option>
</select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: 870px;"><span class="selection"><span class="select2-selection select2-selection--multiple" role="combobox" aria-haspopup="true"
aria-expanded="false" title="Do you qualify for government benefits such as unemployment insurance?" tabindex="-1">
<ul class="select2-selection__rendered">
<li class="select2-search select2-search--inline"><input class="select2-search__field" type="search" tabindex="0" autocomplete="off" autocorrect="off" autocapitalize="off" spellcheck="false" role="textbox" aria-autocomplete="list"
placeholder="- Select -" style="width: 868px;"></li>
</ul>
</span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_2935548660157477_MappedSurveyQuestion_382907">
<div class="form-unit form-unit-radio form-item-customformfieldquestion_2935548660157477_mappedsurveyquestion_382907" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_2935548660157477_MappedSurveyQuestion_382907"><label
id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_2935548660157477_MappedSurveyQuestion_382907"> Does your family have enough to eat right now? <small>(Optional)</small></label>
<div class="radios" role="radiogroup" aria-labelledby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_2935548660157477_MappedSurveyQuestion_382907">
<label title="Yes" class="at-radio-label-1571695" role="radio">
<input type="radio" name="CustomFormFieldQuestion_2935548660157477_MappedSurveyQuestion_382907" value="1571695"> Yes </label><label title="No" class="at-radio-label-1571696" role="radio">
<input type="radio" name="CustomFormFieldQuestion_2935548660157477_MappedSurveyQuestion_382907" value="1571696"> No </label><label title="Uncertain" class="at-radio-label-1571697" role="radio">
<input type="radio" name="CustomFormFieldQuestion_2935548660157477_MappedSurveyQuestion_382907" value="1571697"> Uncertain </label>
</div>
</div>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_60448556842129_MappedParagraphQuestion_2376995449573657">
<label class="at-area CustomFormFieldQuestion_60448556842129_MappedParagraphQuestion_2376995449573657" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_60448556842129_MappedParagraphQuestion_2376995449573657">Is there
anything else you would like us to know about your economic situation or anything else? <small>(Optional)</small><textarea false="" title="Is there anything else you would like us to know about your economic situation or anything else?"
name="CustomFormFieldQuestion_60448556842129_MappedParagraphQuestion_2376995449573657" maxlength="8000"></textarea>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_3876456237960973">
<label class="at-text CustomFormFieldQuestion_3876456237960973" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_3876456237960973">How many weeks can you afford groceries for? <small>(Optional)</small><input type="text"
autocomplete="on" false="" title="How many weeks can you afford groceries for?" name="CustomFormFieldQuestion_3876456237960973" value="" maxlength="75">
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_4232263293901945">
<div id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4232263293901945"><label name="CustomFormFieldQuestion_4232263293901945" class="checkbox-list-label"> How did you hear about this fund? <br>
<small class="checkbox-list-required-text" name="CustomFormFieldQuestion_4232263293901945-small" style="display: none"><b>How did you hear about this fund? is required.</b></small>
</label>
</div>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_4232263293901945_CustomFormFieldQuestion_4802797953973579">
<label class="at-check CustomFormFieldQuestion_4232263293901945_CustomFormFieldQuestion_4802797953973579" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4232263293901945_CustomFormFieldQuestion_4802797953973579"><input
type="checkbox" name="CustomFormFieldQuestion_4232263293901945_CustomFormFieldQuestion_4802797953973579" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4232263293901945"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4232263293901945_CustomFormFieldQuestion_4802797953973579-label">Social Media</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_4232263293901945_CustomFormFieldQuestion_8379063806389833">
<label class="at-check CustomFormFieldQuestion_4232263293901945_CustomFormFieldQuestion_8379063806389833" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4232263293901945_CustomFormFieldQuestion_8379063806389833"><input
type="checkbox" name="CustomFormFieldQuestion_4232263293901945_CustomFormFieldQuestion_8379063806389833" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4232263293901945"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4232263293901945_CustomFormFieldQuestion_8379063806389833-label">Friend</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_4232263293901945_CustomFormFieldQuestion_4541031742780359">
<label class="at-check CustomFormFieldQuestion_4232263293901945_CustomFormFieldQuestion_4541031742780359" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4232263293901945_CustomFormFieldQuestion_4541031742780359"><input
type="checkbox" name="CustomFormFieldQuestion_4232263293901945_CustomFormFieldQuestion_4541031742780359" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4232263293901945"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4232263293901945_CustomFormFieldQuestion_4541031742780359-label">News Article</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_4232263293901945_QuestionOtherResponse_5356695859812253">
<label class="at-check CustomFormFieldQuestion_4232263293901945_QuestionOtherResponse_5356695859812253" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4232263293901945_QuestionOtherResponse_5356695859812253"><input
type="checkbox" name="CustomFormFieldQuestion_4232263293901945_QuestionOtherResponse_5356695859812253" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4232263293901945"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_4232263293901945_QuestionOtherResponse_5356695859812253-label">Other</span></span>
</label>
<label class="at-text QuestionOtherResponse_5356695859812253_QuestionOtherTextResponse_1722013585746429" id="NVSignupForm1428411-AdditionalInformation-QuestionOtherResponse_5356695859812253_QuestionOtherTextResponse_1722013585746429"
style="display: none;"><kbd>Other</kbd><input type="text" autocomplete="on" required="" title="Other (required)" name="QuestionOtherResponse_5356695859812253_QuestionOtherTextResponse_1722013585746429" value="" maxlength=""
placeholder="Other*">
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_7043766622273851">
<div class="form-unit form-unit-radio form-item-customformfieldquestion_7043766622273851" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7043766622273851"><label
id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7043766622273851"> Are you 18 years or older?</label>
<div class="radios" role="radiogroup" aria-labelledby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_7043766622273851">
<label title="Yes" class="at-radio-label-2161114131472367" role="radio">
<input type="radio" name="CustomFormFieldQuestion_7043766622273851" value="2161114131472367"> Yes </label><label title="No" class="at-radio-label-1407883813924099" role="radio">
<input type="radio" name="CustomFormFieldQuestion_7043766622273851" value="1407883813924099"> No </label>
</div>
</div>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_6704387240445621">
<div class="form-unit form-unit-radio form-item-customformfieldquestion_6704387240445621" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_6704387240445621"><label
id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_6704387240445621"> Are you a US Citizen?</label>
<div class="radios" role="radiogroup" aria-labelledby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_6704387240445621">
<label title="Yes" class="at-radio-label-796247200804389" role="radio">
<input type="radio" name="CustomFormFieldQuestion_6704387240445621" value="796247200804389"> Yes </label><label title="No" class="at-radio-label-540543179666175" role="radio">
<input type="radio" name="CustomFormFieldQuestion_6704387240445621" value="540543179666175"> No </label>
</div>
</div>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_2575982437002915">
<div class="form-unit form-unit-radio form-item-customformfieldquestion_2575982437002915" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_2575982437002915"><label
id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_2575982437002915"> Are you willing/able and available to canvas on November 8th, 2022 for at least 5 hours?</label>
<div class="radios" role="radiogroup" aria-labelledby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_2575982437002915">
<label title="Yes" class="at-radio-label-4453295548065811" role="radio">
<input type="radio" name="CustomFormFieldQuestion_2575982437002915" value="4453295548065811"> Yes </label><label title="No" class="at-radio-label-5775632967418521" role="radio">
<input type="radio" name="CustomFormFieldQuestion_2575982437002915" value="5775632967418521"> No </label><label title="Unsure" class="at-radio-label-2847668722297151" role="radio">
<input type="radio" name="CustomFormFieldQuestion_2575982437002915" value="2847668722297151"> Unsure </label>
</div>
</div>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_2028766017155049">
<div id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_2028766017155049"><label name="CustomFormFieldQuestion_2028766017155049" class="checkbox-list-label"> Do you personally affirm that the above information is valid and
truthful to the best of your abilities, and that you are not submitting any of this information with the intent to mislead or defraud? <br>
<small class="checkbox-list-required-text" name="CustomFormFieldQuestion_2028766017155049-small"
style="display: none"><b>Do you personally affirm that the above information is valid and truthful to the best of your abilities, and that you are not submitting any of this information with the intent to mislead or defraud? is required.</b></small>
</label>
</div>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_2028766017155049_CustomFormFieldQuestion_7145952673184425">
<label class="at-check CustomFormFieldQuestion_2028766017155049_CustomFormFieldQuestion_7145952673184425" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_2028766017155049_CustomFormFieldQuestion_7145952673184425"><input
type="checkbox" checked="" name="CustomFormFieldQuestion_2028766017155049_CustomFormFieldQuestion_7145952673184425" aria-describedby="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_2028766017155049"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVSignupForm1428411-AdditionalInformation-CustomFormFieldQuestion_2028766017155049_CustomFormFieldQuestion_7145952673184425-label">Yes</span></span>
</label>
</div>
</div>
</fieldset>
<div class="at-form-submit clearfix">
<input type="submit" value="Submit" class="at-submit btn-at btn-at-primary">
<div class="at-markup secure-processing-single-step-div" style="display: none;">
<label class="secure-processing-label at-text"> Your donation will be securely processed.<div class="glyphicons glyphicons-lock" aria-hidden="true"></div>
</label>
</div>
</div>
</form>POST
<form class="clearfix" method="post" novalidate="" action="" accept-charset="utf-8" autocomplete="on">
<div data-name="undefined" data-subview="submit_view" data-subview-index="1"></div>
<fieldset class="at-fieldset ContactInformation" id="NVVolunteerForm1432796-ContactInformation">
<legend class="at-legend">Contact Information</legend>
<div class="at-fields">
<div class="at-row FirstName LastName"><label class="at-text FirstName" id="NVVolunteerForm1432796-ContactInformation-FirstName">First Name<input type="text" autocomplete="given-name" x-autocompletetype="given-name" required=""
title="First Name (required)" name="FirstName" value="" maxlength="20">
</label><label class="at-text LastName" id="NVVolunteerForm1432796-ContactInformation-LastName">Last Name<input type="text" autocomplete="family-name" x-autocompletetype="surname" required="" title="Last Name (required)" name="LastName"
value="" maxlength="25">
</label></div>
<div class="at-row at-row-solo PostalCode"><label class="at-text PostalCode" id="NVVolunteerForm1432796-ContactInformation-PostalCode">Postal Code<input type="tel" autocomplete="postal-code" x-autocompletetype="postal-code"
pattern="^\d{5}([\-]\d{4})?$" required="" title="Postal Code (required)" name="PostalCode" value="" maxlength="10">
</label></div>
<div class="at-row EmailAddress MobilePhone"><label class="at-text EmailAddress" id="NVVolunteerForm1432796-ContactInformation-EmailAddress">Email<input type="email" autocomplete="email" x-autocompletetype="email"
pattern="^([\w!#$%&'*+\-\/=?\^`\{\|\}~]+\.)*[\w!#$%&'*+\-\/=?\^`\{\|\}~]+@((((([a-zA-Z0-9]{1}[a-zA-Z0-9\-]{0,62}[a-zA-Z0-9]{1})|[a-zA-Z])\.)+[a-zA-Z]{2,62})|(\d{1,3}\.){3}\d{1,3}(:\d{1,5})?)$" required="" title="Email (required)"
name="EmailAddress" value="" maxlength="100" placeholder="email@email.com">
</label><label class="at-text MobilePhone" id="NVVolunteerForm1432796-ContactInformation-MobilePhone">Mobile Phone<input type="tel" autocomplete="mobile tel-national"
pattern="^(?:\+?1[\-. ]?)?(?:\(?([2-9]\d{2})\)?)[\-. ]?([2-9]\d{2})[\-. ]?(\d{4})(?:\s{0,2}(?:ext(?:ension)?|ex|x)\.?\s?(\d{1,5}))*$" required="" title="Mobile Phone (required)" name="MobilePhone" value="" maxlength="">
</label></div>
<div class="at-row "><label class="at-text PersonalUrl" id="NVVolunteerForm1432796-ContactInformation-PersonalUrl"> <small>(Optional)</small><input type="text" autocomplete="on" false="" title="" name="PersonalUrl" value="" maxlength="">
</label></div>
<div class="at-row ">
<div class="at-markup TrackingPixel" id="NVVolunteerForm1432796-ContactInformation-TrackingPixel" style="display: none;"><img alt=""
src="https://secure.everyaction.com/v1/Track/wRPZ4z7bV0ik1h0DxOf52g2?formSessionId=894ba0f9-981c-4059-b728-c48ac8cf0add&bName=chrome&dType=desktop&formVersion=1/17/2023 12:23:26 AM|&fUrl=aHR0cHM6Ly93d3cub2Z3YWN0aW9uLmNvbS9hcml6b25h&fRef="
style="display:none"></div>
</div>
</div>
</fieldset>
<fieldset class="at-fieldset AdditionalInformation" id="NVVolunteerForm1432796-AdditionalInformation">
<legend class="at-legend">Which area are you closest to (check all that apply):</legend>
<div class="at-fields">
<div class="at-row at-row-full CustomFormFieldQuestion_1431774726558061">
<div id="NVVolunteerForm1432796-AdditionalInformation-CustomFormFieldQuestion_1431774726558061"><label name="CustomFormFieldQuestion_1431774726558061" class="checkbox-list-label"> Which area are you closest to (check all that
apply): <br>
<small class="checkbox-list-required-text" name="CustomFormFieldQuestion_1431774726558061-small" style="display: none"><b>Which area are you closest to (check all that apply): is required.</b></small>
</label>
</div>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_1254282772511043">
<label class="at-check CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_1254282772511043"
id="NVVolunteerForm1432796-AdditionalInformation-CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_1254282772511043"><input type="checkbox"
name="CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_1254282772511043" aria-describedby="NVVolunteerForm1432796-AdditionalInformation-CustomFormFieldQuestion_1431774726558061"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVVolunteerForm1432796-AdditionalInformation-CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_1254282772511043-label">Central Phoenix</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_8149470099015115">
<label class="at-check CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_8149470099015115"
id="NVVolunteerForm1432796-AdditionalInformation-CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_8149470099015115"><input type="checkbox"
name="CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_8149470099015115" aria-describedby="NVVolunteerForm1432796-AdditionalInformation-CustomFormFieldQuestion_1431774726558061"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVVolunteerForm1432796-AdditionalInformation-CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_8149470099015115-label">North Central
Phoenix</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_8123632860957663">
<label class="at-check CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_8123632860957663"
id="NVVolunteerForm1432796-AdditionalInformation-CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_8123632860957663"><input type="checkbox"
name="CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_8123632860957663" aria-describedby="NVVolunteerForm1432796-AdditionalInformation-CustomFormFieldQuestion_1431774726558061"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVVolunteerForm1432796-AdditionalInformation-CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_8123632860957663-label">South Phoenix</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_8673461668844769">
<label class="at-check CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_8673461668844769"
id="NVVolunteerForm1432796-AdditionalInformation-CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_8673461668844769"><input type="checkbox"
name="CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_8673461668844769" aria-describedby="NVVolunteerForm1432796-AdditionalInformation-CustomFormFieldQuestion_1431774726558061"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVVolunteerForm1432796-AdditionalInformation-CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_8673461668844769-label">West Phoenix</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_797183281247683">
<label class="at-check CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_797183281247683"
id="NVVolunteerForm1432796-AdditionalInformation-CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_797183281247683"><input type="checkbox"
name="CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_797183281247683" aria-describedby="NVVolunteerForm1432796-AdditionalInformation-CustomFormFieldQuestion_1431774726558061"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVVolunteerForm1432796-AdditionalInformation-CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_797183281247683-label">Mesa/Tempe</span></span>
</label>
</div>
<div class="at-row at-row-full CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_7429990304322341">
<label class="at-check CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_7429990304322341"
id="NVVolunteerForm1432796-AdditionalInformation-CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_7429990304322341"><input type="checkbox"
name="CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_7429990304322341" aria-describedby="NVVolunteerForm1432796-AdditionalInformation-CustomFormFieldQuestion_1431774726558061"> <span
class="at-checkbox-title-container"><span class="at-checkbox-title" id="NVVolunteerForm1432796-AdditionalInformation-CustomFormFieldQuestion_1431774726558061_CustomFormFieldQuestion_7429990304322341-label">Tucson</span></span>
</label>
</div>
</div>
</fieldset>
<div class="at-form-submit clearfix">
<input type="submit" value="Submit" class="at-submit btn-at btn-at-primary">
<div class="at-markup secure-processing-single-step-div" style="display: none;">
<label class="secure-processing-label at-text"> Your donation will be securely processed.<div class="glyphicons glyphicons-lock" aria-hidden="true"></div>
</label>
</div>
</div>
</form>Text Content
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RAISE THE WAGE ARIZONA
ABOUT #RAISETHEWAGE ARIZONA
One Fair Wage Action works across the nation to make sure that tipped workers
get the same full minimum wage as everyone else, with tips on top. In Arizona,
the subminimum wage for tipped workers is just $9.80 an hour, which leaves many
workers, especially women, immigrants, and people of color subject to harassment
and discrimination due to the reliance on tips as wage replacement. Workers are
pushing lawmakers and key decision-makers to advocate and pass legislation that
would finally give them One Fair Wage. Simultaneously, we are also considering
filing a ballot initiative that would leave it to the people to decide on this
important issue. Arizona is a shining example of the persistent popular support
for One Fair Wage. When workers unite, they win!
The Covid-19 pandemic changed everything. Millions of workers have left or are
leaving the restaurant industry due to low wages and tips and increased health
risks, hostility and harassment. Thousands of restaurants nationwide, including
hundreds in Arizona, have raised their wages to attract and retain staff. But
they need a level playing field, and in order to do so, we need to finally make
One Fair Wage a reality.
AZ Service Worker Fund
AZ SERVICE WORKERS FUND
AZ service workers are realizing they can elevate their voices, participate in
our democratic system and take real action in demanding a fair wage — and we're
supporting them with the Service Worker Fund
We have set up the “AZ Service Worker Fund” to support service workers ( tipped
workers, restaurant workers, retail workers, or any worker who earns less than
$18/hr) who would like to learn and participate in the democratic process that
will make real and lasting change in their workplace! We know that standing up
for your rights is hard, and sometimes puts people in vulnerable positions. We
are here to help folks who are willing and able to participate in changing their
futures, and fighting to build a better workplace for themselves and for their
communities!
Requirements for eligibility in the AZ Service Worker Fund
1. service workers who have worked since January 2020 and have worked for less
than $18/hr.
2. Service workers are defined as: tipped workers, restaurant workers, retail
workers, or any worker who earns less than $18/hr.
3. Must be willing and able to canvass in person.
4. Must be eligible to legally canvass.
Also, the geographic focus of the fund is limited to Maricopa + Pima counties.
Contact Information
First Name Last Name
Preferred Language- Select
-AmharicArabicArmenianASLBengaliBhutaneseBosnianBulgarianBurmeseCantoneseChamorroCreoleCroatianCzechDanishDutchEnglishEstonianFilipinoFinnishFrenchGermanGreekGujaratiHebrewHindiHmongHungarianIcelandicIlocanoIndonesianItalianIu
MienJapaneseKannadaKarenniKhmerKoreanLaoLatvianLithuanianMalayMalayalamMandarinMarathiNepaliNorwegianNot
ListedPolishPortuguesePunjabiRussianSamoanSerbianSimplified
ChineseSinhalaSlovakSomaliSpanishSwahiliSwedishTagalogTamilThaiTibetanTigrinyaTokelauanTraditional
ChineseTurkishUkranianUrduVietnamese
*
Pronouns- Select -(F)ae/(F)aer/(F)aersAny/All
PronounsE/Em/EirsEy/Em/EirsHe/Him/HisHe/She/TheyHe/Them/TheirsName
OnlyPer/Per/PersShe/Her/HersShe/Them/TheirsSie/Sie/HirsTey/Ter/TersThey/Them/TheirsVe/Ver/VersVe/Ver/VisXe/Xem/XyrsZe/Hir/HirsZie/Zim/Zis
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MaleFemaleFemmeFTMGender FluidGender Non-conformingGender QuestioningGender
VariantGenderlessGenderqueerIntersexMaleMascMTFNeitherNeutroisNon-BinaryNon-OpNot
ListedPangenderPolygenderPrefer Not to SayQueerQuestioningThird
GenderTransfeminineTransgenderTransgender FemaleTransgender MaleTransgender
PersonTransmasculineTwo Spirit
*
Sexual Orientation- Select -AsexualBisexualDemisexualGayHeterosexualLesbianNot
ListedPansexual/OmnisexualPrefer not to SayQueer
*
Race- Select -Asian or Asian AmericanBlack or African AmericanHispanicMiddle
EasternMulti-racialNative AmericanNative HawaiianNot ListedPacific IslanderWhite
*
Ethnicity- Select -AfghaniAfrican
AmericanArabArabianArmenianBangladeshiBengaliBhutaneseBrazilianBulgarianBurmeseCambodianChamorroChinChineseCzechoslovakianDanishDutchEast
AfricanEgyptianEnglish
(British)EstonianEthiopianFilipinoFinnishFrenchGermanGreekHaitianHawaiianHispanicHmongHungarianIcelandicIndianIndo
CarribeanIndonesianIranianIrishItalianJapaneseKarenKoreanLaoLatinoLatvianLebaneseLithuanianMalaysianManxMienMixed
EthnicityMongolianMorrocanNative AlaskanNative AmericanNepaliNon-Hispanic
WhiteNorwegianNot ListedOkinawanPacific
IslanderPakistaniPersianPolishPortugueseRussianSamoanScottishSingaporeanSomaliSri
LankanSwedishSwissTagalogTaiwaneseThaiTibetanTonganTurkishUkrainianUnknownVietnameseWelshYemeniYugoslavian
*
Street Address
Postal Code City State/Province- State
-AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWYASFMGUMHMPPRPWVIAAAEAP
Email Home Phone
Mobile Phone
By submitting your cell phone number you are agreeing to receive periodic text
messages from this organization. Message and data rates may apply. Text HELP for
more information. Text STOP to stop receiving messages.
(Optional)
Additional Information
Which area are you closest to (check all that apply):
Which area are you closest to (check all that apply): is required.
Central Phoenix
North Central Phoenix
South Phoenix
West Phoenix
Mesa/Tempe
Tucson
Which state do you work in?- Select
-AKALARASAZCACOCTDCDEFLGAGUHIIAIDILINKSKYLAMAMDMEMIMNMOMPMSMTNCNDNENHNJNMNVNYOHOKORPAPRRISCSDTNTXUTVAVIVTWAWIWVWY
Can you tell us the name of the establishment where you work currently or most
recently worked?
Which best describes the establishment where you work(ed)?- Select -Casual, full
serviceFast FoodFine-diningOther tipped
When were you last employed at the above establishment?- Select -Currently
employedLeft before April 1 2021Left after April 1 2021
Are you willing to sign on to our petition for One Fair Wage?
Are you willing to sign on to our petition for One Fair Wage? is required.
Yes
No
What motivated you to apply for the fund?
You can view the text of the petition and sign it right now by clicking here.
Are you interested in joining with other current and former service workers to
fight for a fair minimum wage for all workers, including tipped workers?- Select
-YesNoUncertain
Do you have children? (Optional)
Do you have children? is required.
Yes
No
Prefer not to answer
How many dependents are you responsible for? (Optional)
How many dependents are you responsible for? is required.
0
1
2
3
4 or More
I Prefer Not To Answer
How many people live in your household, including you? - as in children or other
adults you support financially? (Optional)- Select -12345678910+
Can you currently afford to make your next rent/mortgage payment? (Optional)
Can you currently afford to make your next rent/mortgage payment? is required.
Yes
No
Not Applicable
Do you qualify for government benefits such as unemployment insurance?
(Optional)- Select -YesNo
*
Does your family have enough to eat right now? (Optional)
Yes No Uncertain
Is there anything else you would like us to know about your economic situation
or anything else? (Optional)
How many weeks can you afford groceries for? (Optional)
How did you hear about this fund?
How did you hear about this fund? is required.
Social Media
Friend
News Article
Other Other
Are you 18 years or older?
Yes No
Are you a US Citizen?
Yes No
Are you willing/able and available to canvas on November 8th, 2022 for at least
5 hours?
Yes No Unsure
Do you personally affirm that the above information is valid and truthful to the
best of your abilities, and that you are not submitting any of this information
with the intent to mislead or defraud?
Do you personally affirm that the above information is valid and truthful to the
best of your abilities, and that you are not submitting any of this information
with the intent to mislead or defraud? is required.
Yes
Your donation will be securely processed.
SHOW YOUR SUPPORT
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AZ Volunteer Form
LOW-WAGE WORKERS NEED YOUR HELP RIGHT NOW! THANK YOU FOR VOLUNTEERING TO GET
FAIR WAGES FOR ALL WORKERS IN ARIZONA! SIGN UP BELOW.
One Fair Wage works across the nation to make sure that tipped workers get the
same full minimum wage as everyone else, with tips on top. In Arizona, the
subminimum wage for tipped workers is just $9.80 an hour, which leaves many
workers, especially women, immigrants, and people of color subject to harassment
and discrimination due to the reliance on tips as wage replacement. Arizona is a
shining example of the persistent popular support for One Fair Wage. When
workers unite, they win!
Contact Information
First Name Last Name
Postal Code
Email Mobile Phone
(Optional)
Which area are you closest to (check all that apply):
Which area are you closest to (check all that apply):
Which area are you closest to (check all that apply): is required.
Central Phoenix
North Central Phoenix
South Phoenix
West Phoenix
Mesa/Tempe
Tucson
Your donation will be securely processed.
SHOW YOUR SUPPORT
WITH A SINGLE CLICK
Autofill forms quickly and securely with FastAction
Sign up with your email address
Already have a FastAction account? Log in
By clicking "Log in," I confirm that I agree with the FastAction terms of
service and privacy policy.
×
SHOW YOUR SUPPORT
WITH A SINGLE CLICK
Autofill forms quickly and securely with FastAction
Log in with your email address
Don't have a FastAction account yet? Sign up
By clicking "Sign up," I confirm that I agree with the FastAction terms of
service and privacy policy.
×
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393 Canal Street Suite #103
New York, NY 10013
ONE FAIR WAGE ACTION