#DemandAccess Ambassador Form
The #DemandAccess campaign seeks equitable access to health and justice for all people by demanding access everywhere it is currently being denied. Guided by the ethos that "For as long as we fund violence to 'keep the peace,' our access -- to healthy bodies, minds and environments -- will always be denied," the campaign advocates for reduced defense spending in order to reinvest in our communities. #DemandAccess is led by young health professionals and involves concerned citizens in a campaign at the intersection of climate harm, nuclear threat, and issues of social and racial justice in service of prioritizing the well-being of under-represented populations.

As an Access Ambassador, you will have the opportunity to take action and demand that Congress prioritize people over profit; over the pentagon. You'll also gain access to professional trainings, networking opportunities, and more!

Fill out this form to begin the process of becoming a #DemandAccess Ambassador today!

**NOTE: Your responses will be kept confidential and will only be used for statistical purposes
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Email *
Full Name (First and Last) *
Preferred Email *
Phone Number
What is your age? *
What is your ethnicity? *
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For ethnicity: if you prefer to self identify, feel free to share here
Which most closely describes your gender? 
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For gender: if you prefer to self identify, feel free to share here
Where are you located? *
What Congressional district do you live in? (If you don't know, you can find out here: https://www.govtrack.us/congress/members/map) *
Please state your employer or institution affiliation(s).
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What is your field of work and/or study? Please describe.
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Are you a member of a PSR Chapter?  *
If so, which one?
What topics, issues, or concerns are you most interested in taking action on? Select your top three.  (Don't hesitate to add a topic, issue or concern in Other) *
Required
What actions would you be willing to take for your causes? *
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What skills would you be most interested in gaining from this Campaign?
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How much time do you realistically have available to dedicate to campaign activities? 
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