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WEAC – Political Action Committee Application Form
Name
First
Last
Address
Street Address
Address Line 2
City
State
Zip
Cell Phone
Home Phone
Home Email
Local Education Association (your local union)
Region or Urban
Ethnic Minority (optional)
American Indian, Eskimo, or Aluet
Asian or Pacific Islander
Black
Caucasian
Hispanic
Resident of Congressional District
CD 1
CD 2
CD 3
CD 4
CD 5
CD 6
CD 7
CD 8
Employed in Congressional District
CD 1
CD 2
CD 3
CD 4
CD 5
CD 6
CD 7
CD 8
Resident of / Employed in which Assembly District
Resident of / Employed in which Senate District
I am a member of the following political party (check one)
Democratic
Republican
Other
Other "political" organizations to which you belong (CUB, WI Environmental Decade, NAACP, etc.)
Please detail responsibilities you have had with Local Screening Committees, School Board Elections, Assembly and Senate races or Congressional Races.
List campaign activities you have done on behalf of candidates (identify the candidate and dates of each campaign specifically, i.e. school board, assembly, senate, congressional race or state constitutional officers)
Signature
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