Polit_form

Form to webmaster to add to APAC Web Site additional
Polish American Candidates running in
The November 2004 Elections

submit the following form

Title:
Candidate First Name*:
Candidate Middle Name:
Candidate Last Name*:
City*:
State*:
Party*:
Candidate For Position:
Comments and any other information about the position:
E-mail Address*:
Web Site, if any:

Information on Person submitting this form:
Name, Address*:
Tel*:	( ) -
E-mail Address*:

* - is a required field