14% of survey complete.

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* 1. Candidate Name:

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* 2. Home Street Address, City, State, Zip:

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* 3. Home or Cell Phone:

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* 4. Personal Email:

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* 5. Campaign Office Address, City, State, Zip:

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* 6. Campaign Phone Number:

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* 7. Campaign Email:

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* 8. Campaign Website:

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* 9. District Number Running in:

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* 10. Party Affiliation:

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* 11. Name of Candidate Committee

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* 12. Campaign Manager and Contact info:

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