Title*: Full Name*:
    City*: State*: Zipcode*:
    Telephone*: Evening Telephone*:
    Email*: Fax:
    Relevant work and volunteer experience:
    I have the following skills that I can share (e.g., writing, speaking, community organizing, media/PR, administrative, fund-raising/grant writing skills; fluency in foreign languages):
    I know the following people who could be useful contacts for Unite America Party (e.g., elected representatives and officials on federal, state, and local levels; organizational, religious, business and labor leaders; contacts in academia and the media):
    Hobbies and special interests:
    If I had all the money, time and energy I needed, I would:

    Time available to volunteer for Unite America Party

    No. of hours*: Per*: I can start *:
    Best Days*: Preferred Time of Day*:
    I prefer to work: At UAP locationsAt homeOn-line/via e-mailNo Preference
    I have my own means of transportation: YesNo

    Unite America Party's Organizational Needs (please check where you would like to help)

    Select topics for each category where you have an interest.

    UAP Publications and Website
    Public Relations
    Fundraising and Membership
    Office Administration
    Other ways I would like to help Unite America Party:
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