* Your Full Name: * Email Address: * Phone Number:

* Party:
Democrat Republican Independent
Please check those that apply: I am actively involved in my party at the following level/s:
Federal State County
If you have a close relationship/connection with a candidate please select:

What is your connection to this candidate?
Please share any contact information for the candidate or candidate’s staff.
If you have endorsed a candidate please select:

Please indicate the ways you are willing to help with the initiative:
Attend candidate events.
Personally invite candidate to forum.
Discuss forum with campaign staff.
Provide ISAC contact information.

Please share any additional ways that you can help the initiative

Please fill out the following information for an event that you attended for a 2016 presidential candidate:

Candidate: Date: Location: Feedback/Discussion:

Counties Connect America Initiative Member SurveyPlease fill out the form below.ISAC Staff, View results here.

Counties Connect America Initiative Member SurveyPlease fill out the form below.
ISAC Staff, View results here.