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Home   »  Congressional District Coordinator

Congressional District Coordinator Questionnaire

Please complete the following brief questionnaire:

First Name
Last Name
Organization
E-mail
Phone Number
Fax Number
Web Page
Mailing Address
 
City
State
Zip
Country
Are you a member of the US Campaign?
What is your congressional district (state and number please)?
Can we post your name on the US Campaign web site?
List any organizational affiliation/s.
Are these organizations affiliated with the US Campaign?
List any advocacy/organizing experience.
Other Comments


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