Contact Information

First Name    M.I.

Last Name    Suffix (Jr., III, etc.)

Home   Please do not publish (Judicial incumbents only)

Mailing Address

City    State    ZIP Code

City/Village/Township of Residence (if different from mailing address)

Phone ( ) -    Fax ( ) -

E-mail

Web Site

Campaign Information

Post Sought President Vice President U.S. Senate U.S. House State Board of Education Michigan State University Board of Trustees University of Michigan Board of Regents Wayne State University Board of Governors State House Supreme Court Court of Appeals

District (number only, if applicable)

Incumbent

Political Party Affiliation Republican Democrat Libertarian Green U.S. Taxpayers Reform Natural Law No Party Affiliation

Campaign Committee

Mailing Address

City    State    ZIP Code

Phone ( ) -    Fax ( ) -

E-mail

Web Site

Personal Information

Gender Male Female

Birth Place    Birth Date Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec / 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 /

Marital Status    Spouse

Education (please include area of study or major and any degrees obtained)

Work History/Military Service

Prior Elective Office Sought/Served

Other Political Activity

Community Organizations

Religion

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