Goddard Riverside Family Council Membership and Survey Form   Please put a check next to those issues of chief concern to you, and which you would like to address to take action. If you prefer to mail out the survey, click here to fill out and print the printer friendly form. Fields marked are required. Tenant protections New housing production Homeless & shelter policies Childcare Public education Early childhood & after school programs Social Security Healthcare: Medicare Medicaid HMO legislation Jobs/employment Summer jobs for youth (SYEP) Welfare/workfare Hunger/Food Stamps Environment Relations with Police Racism Immigration issues Global economy/World Trade & labor issues: Other issues (specify:) Are you interested in volunteering? Assist with Mailings (envelope stuffing) and flyer distribution Attend Coalition meetings to represent Family Council (Day or Night) Attend demonstration Participate in Lobbying (in NYC, Albany or Washington) Other skills to offer: Would you like to remain on our mailing list for meeting and action notices? Yes No First Name Last Name Affiliation Street address Address 2 City State Zip code Phone Fax E-mail Click here to submit the form This form is being sent to: Larry Wood Goddard Riverside Community Center 593 Columbus Avenue New York, NY 10024 For more information call 212-873-6600 extension 304