VCAC - Membership Signup Form

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In the form below, enter the basic demographic data. Name and email address are required (if you are entering this data for someone who does not have an email address, use your own) and all other fields are optional. HOWEVER, the usefulness of this data for organizing purposes is directly related to its completeness, so we STRONGLY urge you to provide as much information as you can. In particular, we will need to know your legislative district including the "A" or the "B". If you do not know it, use the map provided by the Minnesota legislature to find it. The Choices section near the end is to identify those tasks which you are willing and able to perform. The Comments can be suggestions as to how to improve this form, or this site...or anything you wish. When you are done, click on the Submit button. To clear the form and start over, click the Clear button.

Please try to follow the directions. Otherwise automated database data entry will enter incorrect values. Also, be very careful entering your email address. If possible, copy and paste it from a known good copy. If you do not, subsequent mailings to you will fail to arrive.

Basic

Name:
Address:
City: State: ZIP:
The phone numbers below must be entered in the format AAA-EEE-NNNN, including the area code.
If you are not entering one, leave the space blank (i.e. don't write "none")
Phone:
FAX:

Political

District:
Party: DFLRepublicanReformLibertarianNone

Internet

Email:
URL:

Choices - Check all that apply

Recruiting Publicity Writing
Web Site Maintenance Research Fundraising
Public Speaking Phonework Artwork
Contact Work Media

Comments

Do NOT hit the enter key until you have written your entire comment.

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