Ciudadanos Venezolanos Americanos 1. Default Section Question Title * 1. Are you a Venezuelan American Citizen?Es Ud. un ciudadano Venezolano Americano? (Required.) yes si no no Question Title * 2. Can you please give Us your information?Puede Ud por favor darnos su información? (Required.) Name: * Company: Address: * Address 2: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Country: Email Address: * Phone Number: Question Title * 3. Are you registered in any Party, which?Esta Ud registrado en algún partido, cual? (Required.) Republican Democrat None Question Title * 4. Give your districts information (See your voting card)Suministre sus distritos (Busquelos en su tarjeta de votacion) precinct # Congress # State Senate # State House # County commission # School Board # Community Council # Question Title * 5. How many people in your household can vote? Cuantas personas en su hogar, votan? Question Title * 6. Do you want to receive our activities information?Quiere Ud recibir información de nuestras actividades Yes Si No No Question Title * 7. City that you or your parents were born in Venezuela?Cual es la Ciudad de nacimiento en Venezuela, suya o de sus Padres? (Required.) Done