CANDIDATE'S NAME

OFFICE SEEKING (District If Applicable)

NAME & CAMPAIGN POSITION OF PERSON COMPLETING FORM

STREET OR PO BOX ADDRESS

CITY, COUNTY, ST, ZIP

PHONE NUMBER

FAX NUMBER

EMAIL ADDRESS

ENTER YOUR THREE (3) SENTENCES

250 Letters Max

(If more than 250 letters, we will only publish the first 250 letters)

NO WEB SITE MENTIONS

You will be contacted by phone before your listing is posted.