The Arab American Institute | include-header | 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.