Personal Information:
Last Name:
First Name:
Town/Village and State:
Street Address:
[Contact information will be removed before it is distributed for review.]
email Address:
Phone Number:
Candidate Information:
Office Sought
Current Status
Polictical Affiliation:
Name of Your Town Democratic Chairperson:
Town Chairperson's Phone Number:
Do you have the support of your local Democratic Committee?:
Not at this time:
Yes:
Education:
High School/GED:
UnderGraduate/AA School/Degree:
Graduate School/Degree:
Work Background Summary:
Public service/Volunteer Activities:
Please send your complete biography to rfromage@frontiernet.net
What are the top 3 issues that you will focus on if elected (be specific):
Provide a brief summary of what you think are the issues in the coming years and what you will do to address them?
Issue 1:
Issue 2:
Issue 3:
Provide a brief summary of what you have done to support the
Democratic Committee and its platfrom during your tenure in office.
Incumbents Only - Accomplishments:
Clear your submission
and restart.
Submit your application.
Blooming Grove Democrat Committee
Application for Endorsement
This form will only go to
the Town Chair and
contact information will
be removed for Judicial
Candidates.
The price of Freedom is eternal Vigilance