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* 1. What is the name of your organization?

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* 2. Provide the first name of a preferred community liaison contact within your organization.

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* 3. Provide the last name of a preferred community liaison contact within your organization.

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* 4. Please provide the title within organization of your preferred contact.

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* 5. Provide a preferred email address for correspondence.

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* 6. Provide a cell phone number if you wish to receive text SMS from the Secretary of State.

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* 7. Provide a general contact email for your organization.

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* 8. Provide a web address for your organization.

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* 9. Provide any social media pages for your organization.

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* 12. Select the community your organization serves. You may choose more than one option.

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* 14. Provide the name of the applicable region that your organization serves (neighborhood, city, county, etc.).

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