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Print out this form and fill it out to sign up for your webpages.
Only the fields marked with * are required.
Begin by Creating a Username and Password
| * Desired Username | |
| * Desired Password | |
| * Confirm Password |
General Information
| * Your full name, as registered (eg Joe Smith) | ||
| * Your last name (eg Smith) | ||
| * Name of elective office you seek | ||
| * What branch of government? |
| |
| * Please indicate your level of office |
| |
| * Is this a special election? | ||
| * Party Affiliation |
| |
| * If 'Other', enter it here | ||
| * Enter population of your constituency (to the nearest 1,000) | ||
| * Make my pages unavailable to the public after this date (i.e. date of primary/general election) |
Office Where You Registered
FOR VERIFICATION PURPOSES
| * Office Name | |
| * ZIP+4 Code | - |
| * Phone Number (including area code) |
Statements
Amount of text is limited to "good taste".
| Here is where you detail your background...the people who influenenced you the most. Your education and experience that give you the convictions that make you a worthy candidate. | |
| Your personal biography | |
| List the qualities which prepared you to aspire to serve your government. | |
| Your qualifications, achievements | |
| Tell us what issues drive your campaign, be them local or national, What voters in your constituency expect you to promote into good law. | |
| The issues as you see them | |
| Specifically, what will you strive to accomplish during your term in office. | |
| Pledges / promises | |
| Problems and your solutions as you see them. Summarize why you're the best candidate for the office you seek. | |
| Why electme! | |
| Type any additional website links you wish to be shown on your webpages here, one per line. Don't forget the http:// in front! | |
| Additional Links | |
Contact Information for Volunteers and Donations
| Address | |
| City | |
| State | |
| Zip | |
| Phone (w/ area code) | |
| Fax (w/ area code) | |
| E-Mail Address |
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