Muslim Caucus Membership Form

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Please fill out this form to apply to be a member of the Muslim Caucus. Your answers will determine if you are a "Voting Member" or an "Associate Member" of the caucus. Voting Members are registered Democrats who are Muslim.

Email *

First Name *

Please indicate your first name as it appears in your voter registration.

Last Name *

Please indicate your last name as it appears in your voter registration.

Address *

City *

Zip Code *

County *

Phone *

Are you Muslim? *

Yes

What is your political affiliation? *

You can check your voter registration here: https://vt.ncsbe.gov/RegLkup/
You may change your party affiliation online if you have an account with the DMV.

Democrat

Unaffiliated or not registered

Another party (Republican, Green, Libertarian, etc.)

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