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Potential Candidates
This form is to be used by potential candidates for political office. Please fill out all the information and we will contact you at our earliest convenience.
Name
Address
City, State, Zip
Phone
Fax
Website
Email
Office Sought
State/District
Primary Date
General Date
Have you ever run for office before?
Yes
No
If Yes, please explain.
Political Affiliation
Please select
Democrat
Republican
Independent
Other
Are you an atheist or theist?
(This is strictly for research purposes. Your answer will remain confidential.)
Please select
Theist
Atheist
Other
Do you support the complete separation of religion and government?
Yes
No
Would you do so if elected to office?
Yes
No
Do you support full civil rights for non-religious Americans like atheists and humanists?
Yes
No
Would you do so if elected to office?
Yes
No
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