VAN ID: Ballot Number: UTAH DEMOCRATIC PARTY CAUCUS ATTENDEE FORM & BALLOT POLITICAL DISTRICT INFORMATION County: Precinct ID: PLEASE PRINT ALL INFORMATION IN INK VOTER INFORMATION – ALL FIELDS ARE REQUIRED
First Name |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| Middle Initial |___| Gender |___|___|___|___|___|___|
Last Name |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| Date of Birth |___|___|/|___|___|/|___|___|___|___|
Street Address |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Apt/Suite/Unit |___|___|___|___| Mailing Address (P.O. Box or RR)|___|___|___|___|___|___|___|___|___|___|
City|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|State |___|___| Zip|___|___|___|___|___|
Home # (___|___|___)|___|___|___|-|___|___|___|___| Cell # (___|___|___)|___|___|___|-|___|___|___|___|
Receive Texts Email |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Have you previously attended a caucus meeting? Yes No
Please Mark All That Apply
I’m most interested in helping with Campaigns for: I have skills or experience with: US President Votebuilder Federal Office (US Senate/House) Issue and/or opposition research Statewide (Governor, Attorney General) Web design/graphic design Utah Legislature Language (please County Offices specify)______
I am interested in joining a caucus (choose as I would like to: many as you’d like): Make phone calls African-American Democrats Have a lawn sign Asian-Pacific Islander Democrats Host a house party Democratic Women Door-to-Door canvassing Education Work on Election Day Environmental Register new voters Healthcare Become a digital volunteer Hispanic Democrats Make a financial contribution Labor LDS Democrats People with Disabilities In the future, I might like to: Progressive Democrats Run for office Native American Caucus Serve on a County or State Executive Rural Democrats Committee Stonewall Democrats Work on a campaign staff Utah Public Employees Volunteer at Democratic Party events Veterans Young Democrats
______Do NOT cut or tear this form______
2016 Presidential Preference Ballot VOTE FOR ONE CANDIDATE