act.berniesanders.com
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URL:
https://act.berniesanders.com/signup/fobs-may22-medicare-for-all/?source=em220512-1-subs&refcode2=9179.11903072.l9lRCW&t=2&aki...
Submission: On May 13 via api from CH — Scanned from DE
Submission: On May 13 via api from CH — Scanned from DE
Form analysis
1 forms found in the DOMName: act — POST /act/
<form class="main__form" name="act" method="POST" action="/act/" accept-charset="utf-8" style="display: block;">
<div id="signup-form" class="main__action slide_up_in ak-labels-overlaid ak-errs-below ak-err-below">
<h3>Sign the petition</h3>
<ul class="compact" id="ak-errors"></ul>
<div id="known_user" style="display: none;"> Not <span id="known_user_name"></span>? <a href="?" onclick="return actionkit.forms.logOut()">Click here.</a>
<hr>
</div>
<div id="unknown_user" class="ak-user-form">
<div id="ak-fieldbox-first_name" class="ak-err-below">
<label for="id_first_name" class="ak-is-overlaid" style="cursor: text; pointer-events: none;"> First name </label>
<input type="text" name="first_name" id="id_first_name" class="ak-userfield-input ak-has-overlay">
</div>
<div id="ak-fieldbox-email" class="required ak-err-below">
<label for="id_email" class="ak-is-overlaid" style="cursor: text; pointer-events: none;"> Email address<span class="ak-required-flag">*</span>
</label>
<input type="text" name="email" id="id_email" class="ak-userfield-input ak-has-overlay">
</div>
<div id="ak-fieldbox-zip" class="required ak-err-below">
<label for="id_zip" class="ak-is-overlaid" style="cursor: text; pointer-events: none;"> ZIP Code<span class="ak-required-flag">*</span>
</label>
<input type="text" name="zip" id="id_zip" class="ak-userfield-input ak-has-overlay">
</div>
<div id="ak-fieldbox-postal" class="ak-err-below" style="display: none;">
<label for="id_postal" class="ak-is-overlaid" style="cursor: text; pointer-events: none;"> Postal code </label>
<input type="text" name="postal" id="id_postal" class="ak-userfield-input ak-has-overlay" disabled="">
</div>
<div id="ak-fieldbox-action_220512-1" class="ak-err-below">
<label for="id_action_220512-1"> Do you agree that it is a national disgrace that America is the only major country on Earth not to provide health care as a right to its people? </label>
<span class="ak-userfield-radio-set"><label class="ak-userfield-radio-choice"><input type="radio" name="action_220512-1" id="id_action_220512-1_yes" class="ak-userfield-input" value="Yes"> Yes</label> <label
class="ak-userfield-radio-choice"><input type="radio" name="action_220512-1" id="id_action_220512-1_no" class="ak-userfield-input" value="No"> No</label> </span>
</div>
<div id="ak-fieldbox-action_220512-2" class="ak-err-below">
<label for="id_action_220512-2"> Do you understand that the insurance companies and the drug companies will do and spend whatever it takes to stop our fight for Medicare for All? </label>
<span class="ak-userfield-radio-set"><label class="ak-userfield-radio-choice"><input type="radio" name="action_220512-2" id="id_action_220512-2_yes" class="ak-userfield-input" value="Yes"> Yes</label> <label
class="ak-userfield-radio-choice"><input type="radio" name="action_220512-2" id="id_action_220512-2_no" class="ak-userfield-input" value="No"> No</label> </span>
</div>
<div id="ak-fieldbox-action_220512-3" class="ak-err-below">
<label for="id_action_220512-3"> We need leaders who will fight for working people, not the billionaires. Can you add a donation to stand with Bernie in creating a government that works for ALL of us? </label>
<span class="ak-userfield-radio-set"><label class="ak-userfield-radio-choice"><input type="radio" name="action_220512-3" id="id_action_220512-3_yes_i_will_chip_in_2_70" class="ak-userfield-input" value="Yes, I will chip in $2.70"> Yes, I will
chip in $2.70</label> <label class="ak-userfield-radio-choice"><input type="radio" name="action_220512-3" id="id_action_220512-3_yes_i_will_chip_in_27" class="ak-userfield-input" value="Yes, I will chip in $27"> Yes, I will chip in
$27</label> <label class="ak-userfield-radio-choice"><input type="radio" name="action_220512-3" id="id_action_220512-3_yes_i_will_chip_in_more_" class="ak-userfield-input" value="Yes, I will chip in more!"> Yes, I will chip in
more!</label> </span>
</div>
<input type="hidden" name="country" value="United States" class="ak-has-overlay">
<div class="ak-privacy ak-errs-below" style="display: none;">
<input type="hidden" name="require_opt_in" value="1" class="ak-has-overlay" disabled="">
<div id="ak-fieldbox-lists" class="ak-err-below">
<label for="lists">
<input type="checkbox" id="lists" name="lists" value="1" disabled=""> Keep me updated with emails about this and other campaigns </label>
</div>
</div>
<!-- ak.wysiwyg=code -->
</div>
<input type="hidden" name="redirect" value="https://secure.actblue.com/donate/fobs-may22-medicare-for-all?refcode=em220512-1-subs&refcode2=9179.11903072.l9lRCW" class="ak-has-overlay">
<input type="hidden" name="action_add_to_sms_list" value="1" class="ak-has-overlay">
<button type="submit" class="main__submit ak-has-overlay">Add Your Name</button>
</div>
<input type="hidden" name="page" value="fobs-may22-medicare-for-all">
<input type="hidden" name="referring_akid" value="9179.11903072.l9lRCW"><input type="hidden" name="source" value="em220512-1-subs"><input type="hidden" name="form_name" value="act"><input type="hidden" name="url"
value="https://act.berniesanders.com/signup/fobs-may22-medicare-for-all/?source=em220512-1-subs&refcode2=9179.11903072.l9lRCW&t=2&akid=9179%2E11903072%2El9lRCW"><input type="hidden" name="js" value="1"><input type="hidden"
name="required" value="zip">
</form>
Text Content
FRIENDS OF BERNIE SANDERS Donate ADD YOUR NAME IN SUPPORT OF MEDICARE FOR ALL Now more than ever, we must do away with our cruel and dysfunctional health care system and join every other major country on earth in guaranteeing health care as a basic human right. Please add your name to Bernie's petition if you agree. SIGN THE PETITION Not ? Click here. -------------------------------------------------------------------------------- First name Email address* ZIP Code* Postal code Do you agree that it is a national disgrace that America is the only major country on Earth not to provide health care as a right to its people? Yes No Do you understand that the insurance companies and the drug companies will do and spend whatever it takes to stop our fight for Medicare for All? Yes No We need leaders who will fight for working people, not the billionaires. Can you add a donation to stand with Bernie in creating a government that works for ALL of us? Yes, I will chip in $2.70 Yes, I will chip in $27 Yes, I will chip in more! Keep me updated with emails about this and other campaigns Add Your Name Friends of Bernie Sanders PO Box 391 Burlington, VT 05402 By providing your cell phone number, you consent to receive periodic campaign updates through automated text messages from Friends of Bernie Sanders. For SMS, Msg & Data rates may apply. Text HELP for help, STOP to end. Privacy Policy. Paid for by Friends of Bernie Sanders (not the billionaires) © Friends of Bernie Sanders | Privacy Policy