MOSES Action

Thank you for your interest in joining MOSES. We look forward to connecting with you!

Instructions for Submission:
Please complete this form and click "Submit." We will process your application upon receipt and contact you with the next steps. Welcome to our community, and thank you for your commitment to social justice! If you need any assistance or have any questions, please reach out to us at mosesmi@mosesmi.org.

Individual Membership Application Form

Contact Information

First Name Last Name

Date of Birth (Optional)

Street Address (Optional)

Postal Code City State

Email Mobile Phone (Optional)

Sign me up for SMS messages.

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.

Yes, sign me up for email updates.

(Optional)

Membership Details

Are you a member of any of the following:
Are you a member of any of the following: is required.

Congregation

Labor Union

Name of Congregation

Name of your local Labor Union

Why do you want to join MOSES? (Please provide a brief explanation)

How did you hear about us? (Check all that apply)
How did you hear about us? (Check all that apply) is required.

Social Media

Friend or Family

Event or Workshop

Website

Other Other

Areas of Interest (Check all that apply)
Areas of Interest (Check all that apply) is required.

Advocacy and Policy

Community Outreach

Education and Training

Event Planning

Fundraising

Volunteer Opportunities

Skills and Experience (Please list any skills or experiences you believe are relevant to your participation in the organization)

Contribution - Membership Type

Student: 16 - 21 years old (Minimum $5) Individual (Annual - Minimum $25) Sustaining Member (Monthly - Minimum $10)

Payment Method

Credit/Debit Card PayPal Check (please mail to our office address) Other Other

Would you like to make an additional donation?

Yes No

If yes, amount: $

Do you require any accommodations to participate in our meetings, training, programs, or events?

Yes No

If yes, please specify:

Emergency Contact Information (Name, Relationship, Phone Number)

Agreement
Agreement is required.

I agree to the terms and conditions of membership as outlined by MOSES.

I consent to receive communications from MOSES, including text messages, newsletters, event invitations, and other updates.

Signature (Please type your name)

Date

Your donation will be securely processed.