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About You

First Name (*)

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Last Name (*)

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Mailing Address (*)

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City (*)

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State (*)

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Zip Code (*)

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Email (*)

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Evening Phone

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Daytime Phone

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Mobile Phone

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Fax

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Best method to reach you:
Any
Email
Phone
Fax
Mail

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Best time to reach you:
Any
Morning
Afternoon
Evening

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Profession

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Work Schedule
Work full-timeWork part-timeDo not workStudent
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Languages


Please select up to three languages in which you are fluent.

First
SpanishTagalogVietnameseFarsiHindiKoreanMandarinCantoneseOther
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Second
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Third
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Preferred Call-to-Action Activities (check all that apply)
Phone Banking
Voter Registration
Precinct Walking
Public Speaking/Speakers Bureau (coordinating and participating in speaking engagements)
Media Committee (letter writing
Calling talk shows volunteer outreach)
Fundraising
Graphic Design/Marketing
Event Planning
Volunteer
Recruitment
Writing Press Releases
Tabling
Letter Writing
Public Access TV
Calling Talk Radio
Office Work
Get-out-the-Vote Activities (GOTV)

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Are you interested in becoming a Precinct Captain?
YesNo
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Would you like to be part of our technical/web committee?
YesNo
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Comments (Special Skills or interests, other languages, additional information)

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