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* 1. What is your first name?

* 2. What is your last name?

* 3. Phone

* 4. E-mail

* 5. What is your mailing address?

* 6. What is your community organization or LULAC Council number (and name):

* 7. What is your title or position in your LULAC Council?

* 8. Are you currently registering voters?

9. If so, how many have you registered to date?

* 10. If you have a voter registration goal, how many voters do you want to register by Election Day?

* 11. List the counties you plan to conduct voter registration/voter education/voter protection or get out the vote.

* 12. Which of the items below are you interested in receiving from LULAC National (check all that apply):

13. Optional:
What Advocacy Issues are most important to your community? (Please check all that apply)

14. Are there any upcoming community festivals/ events where you can conduct voter registration? (Please list date and event name)

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