Progressive Voter Alliance Signup

DONA ANA COUNTY, NEW MEXICO

PVA SIGNUP FORM

Please fill out the following information — important for voter mobilization —

and indicate the frequency of contact from PVA that you would prefer.

First Name	Middle Initial	Last Name
Address:
Number, Street
Apt
City
State
ZIP

Phone
E-mail
Precinct Number

(If you don’t know your precinct number, don’t worry, we will get it from your name and address.)


Did you hear about PVA through another organization?	Yes No

If Yes, what is the name of the organization?

Please check all of the below that apply to you:

Please send me announcements of PVA meetings and occasional updates of PVA activities

The Progressive Voter Alliance occasionally makes mailing addresses and phone numbers (but not e-mail addresses) available to progressive organizations and candidates for grassroots organizing in specific campaigns. Please check the box below if you do not want your information shared with these other other organizations.

I do not want my mailing adress or phone number shared with other organizations.

PVA SIGNUP FORM

Address:

Please check all of the below that apply to you: