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Pacifica Election Mail House Request Form
Review the Mailing List Confidentiality and Data Use Agreement Here:
English
-
Spanish
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Radio Station Affiliation
*
KPFA
KPFT
KPFK
WBAI
WPFW
Which mailing list would you like access to?
*
Listeners
Staff and Volunteers
Are you an individual candidate or running on a slate?
*
Individual Candidate
Running on a Slate
If you are running on a slate, please include the slate name and list candidates connected to your slate:
PLEASE obtain candidate’s permission before submission as everyone will be responsible for all content on mail house promotions.
Which mailing house(s) will you be using?
*
Bacchus Press
Cornerstone Services
Submit
Should be Empty: