Run for Office

This is a form we require so that if you do become our candidate, we have information to post on our website and give to the media. Feel free to leave a section blank if it's not applicable to your office.

First Name: *

Last Name: *

Address 1:

Address 2:

County:

City:

State:

ZIP code:

Hometown:

Daytime Phone Number:

Evening Phone Number:

Mobile Phone/Pager Number:

Fax:

E-mail: *

What office would you like to run for for and why?:

Occupation:

Employer/School:

Highest Level of Education Achieved:

Do you belong to any community organizations?:

yes

If yes, which ones?:

BRIEFLY tell us your stance on the following issues, as they relate to your office:

Gay Marriage Discrimination Amendment:

Property Tax 1-2-3 Caps/Repeal:

Fairtax:

Government Spending:

Public Education:

Township/Fire Consolidation:

Minimum/Maximum Wage:

Business Regulations:

Smoking Bans:

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Submitted by liberty on Tue, 2010-02-09 17:06

Run for Office

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