JOURNAL Pure Harlem Association

Thank YOU for your interest in PURE HARLEM. This Survey does not automatically give you a Membership in Pure Harlem Association. This survey will not qualify you or disqualify your Membership in Pure Harlem. It is only instituted for us to better understand the needs of our Community without pressure. If you want a Membership go to pureharlem.org and sign up. It starts at FREE.


1. NAME

2. EMAIL

3. Are you a Registered Voter
YES NO

4. IF NO, WHY NOT?

5. What is your date of birth ? MM/DD/YYYY

6. Where are you located? (Country, State, City )

7. Do you have a business?
YES NO

8. What type?

9. Did you actually read TERMS? PRIVACYPOLICY ?
YES NO

10. What are you interested in? Select all that apply.
Volunteering ProfessionalDevelopment Mentoring Advocating Resources & Services Meeting People

Contact Details

Name(*)

Email(*)

Phone




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