Draft Nader Volunteer Form

Volunteer Form
First Name:
Last Name:
City:
State:
Zip:	(US ZIP Code (5 digits))
Phone:	(Phone Number)
Email:	(E-mail)
Political Affiliation
Member of Green Party :	Yes No

Independent / No Affiliation	Yes No
Democratic:	Yes No
Republican:	Yes No
Other:
constituencies for Nader
Labor for Nader:	Yes No
Youth for Nader:	Yes No
African-Americans for Nader:	Yes No
Arab-Americans for Nader:	Yes No
Asian-Americans for Nader:	Yes No
Latino-Americans for Nader:	Yes No
Native-Americans for Nader:	Yes No
Comments: