Candidate and Campaign Information

Candidate Info - Name should be as it will appear on your nominating petition.

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* I understand that my name and address will be used on ballot petitions so they should be listed exactly as they appear on my voter registration.

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* First Name

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* Middle Name or Initial (Only include if included on your voter registration)

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* Last Name

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* Suffix (Only include if included on your voter registration)

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* Current Profession

Legal Residence Where Registered to Vote

Must Be Exactly the Same as Your Voter Registration Address for Ballot Petitioning

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* Address Line 1

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* Address Line 2 (Only include if included on your voter registration)

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* City

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* Zip Code

Candidate Contact Info

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* Cell Phone

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* Work Phone

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* Home Phone

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* Email (Non-governmental)

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* Confirm Email (Non-governmental)

Campaign and Committee Info

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* Short Candidate Bio

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* Committee Name

Campaign Headquarters Address

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* Campaign Address

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* Campaign Address 2

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* Campaign City

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* Campaign Zip

Web Resources

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* Campaign Email

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* Campaign Website

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* Campaign Twitter

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* Campaign Facebook

Campaign Manager Info

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* Campaign Manager Name

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* Campaign Manger Cell Phone

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* Campaign Manger Email

 
7% of survey complete.

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