Peoples' Senate Membership Agreement

Organizations: Please fill all sections.

Individuals: Please fill only Name, Address, Phone, Email & Agreement.

First Name *

Last Name *

Name of Organization

Official Representative(s)

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

AGREEMENT

(print name) *

agrees to be a member of the Peoples’ Senate and to work with other member organizations and individuals in striving to uphold the Vision and Mission Statements of the Peoples’ Senate and work towards its proliferation, development and establishment throughout the U.S..

(print name) *

agrees with and support the political position and outcome of the 2021 International Tribunal which found the U.S. guilty of five counts of genocide against Black, Brown, and Indigenous peoples, specifically: 1) “Police Racism and Violence” 2) “Mass Hyper-Incarceration” 3) “Political Prisoners and Prisoners of War” 4) “Environmental Racism” and 5) “Public Health Inequities.”

Today's date * +

Individual Signature *

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Region or constituency *

(for Organizations) Two Signatures Required:

Print name of Official Organization Representative (1)

Date +

Signature of Official Organization Representative (1)

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Print name of Official Organization Representative (2)

Date +

Signature of Official Organization Representative (2)

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