Adopt-A-Precinct Interest Form Question Title * 1. Group's Name Question Title * 2. Group's Address Address Address 2 City/Town State/Province -- 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/Postal Code Question Title * 3. Group's Phone Number Phone Number Question Title * 4. Type of Group Business Church College Student Organization Fraternity or Sorority High School Student Organization Kiwanis Club Masonic Lodge Neighborhood/Community Association Nonprofit Agency PTA/PTSA Rotary Club Other Question Title * 5. Coordinator's Name Question Title * 6. Coordinator's Email Email Address Question Title * 7. Coordinator's AddressOnly if different from group's address, above. Address Address 2 City/Town State/Province ZIP/Postal Code Question Title * 8. Coordinator's Phone NumberOnly if different from group's phone number, above. Phone Number Question Title * 9. Preferred Area to Work in Orange County Question Title * 10. How did you hear about the Adopt-A-Precinct program? Done
