Candidates
Name
*
First Name
Last Name
Seat you are seeking
*
Party
*
Address (Not for Publication)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email (Not for Publication)
*
Confirmation Email
example@example.com
Cell Phone Number (Not for Publication)
*
Please enter a valid phone number.
Birth Date (Not for Publication)
*
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Month
-
Day
Year
Date
Candidate Website
Occupation
*
Platform
*
Experience
*
Family
*
Candidate Photo
*
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