The Arab American Institute | Roster of Arab Americans in Public Service and Political Life Update Form

Roster of Arab Americans in Public Service and Political Life Update Form

Email:*

First Name:*

Last Name:*

Address:

City:

State/Region/Province:

Zip / Postal Code:

Phone:*

CONTACT INFORMATION FOR PERSON FILLING OUT FORM

Name (Last, First):*

Email Address:*

Phone Number (No dashes or spaces):*

YOUR CURRENT INFORMATION
Please enter additional positions (if applicable) in the "Additional Information" area at the bottom of this form.

Current Position:*

Jurisdiction:*

Term (ex. 11/08 - Current):*

Elected or Appointed? (check all that apply):

Elected
Appointed
Staff Position
Political Professional

If elected, do you plan to run for re-election?:

Yes
No

If appointed, please indicate by whom.:

YOUR UPCOMING CAMPAIGNS

Office to be sought:

Party (if applicable):

Filing Deadline (ex. 11/05/09):

Primary Election (ex. 11/05/09):

General Election (ex. 11/05/09):

The national ALC also maintains party caucuses
Please indicate if you would like to be listed as a member of one of the caucuses:

Arab American Caucus:*

Additional Information:

* denotes required field

Our Privacy Statement:
The Arab American Institute is dedicated to protecting your privacy. AAI does not sell or share email addresses or other information with third parties.