Caucus Member Registration

Please use your name as it appears on your Voter Registration. This is important because your registration will be verified by our secretary (as per our bylaws). Your name and address will need to match.

First Name*

Middle Name

Last Name*

Address (line 1)*

Address (line 2)

City*

State*

Zip*

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Select the Fuerzas Unidas Metro or Rural Regional District in which you live. (If you are unsure, refer to this map.)

Metro or Rural District*

County of Residence*

Congressional District*

Current Occupation*

Enter Retired, if you are retired.

The following questions are to identify your membership type and to verify that you agree with our mission statement.

Membership Type*

Voting Member - I identify as one of the following: Nuevomexicano, Hispanic, Latina, Latino, Latinx, Chicana, Chicano, Chicanx, Puerto Riqueño/a, Afro-Caribbean, South American, Central American, Indo-Hispano, Mexican AmericanNon-voting Member

Mission Statement*

I agree with the Mission Statement as stated in the Fuerzas Unidas Caucus Bylaws.I do not agree

Your Personal Information

Membership Agreement