Ballot PA Media Interest Form

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In a critical election year, reporters have already begun reaching out to the Ballot PA campaign hoping to speak with/interview Independent voters in Pennsylvania. They are interested in why so many voters consider themselves Independents (43 percent of all voters according to a recent Gallup poll), and what independents' perspectives are when it comes to current high-profile races.

Would you be interested in speaking with a reporter? We're looking to build a shortlist of individuals across Pennsylvania who would be willing to speak with members of the press if called upon to do so. Whether you're registered Independent/unaffiliated, or simply consider yourself Independent (since our closed primary system forces so many voters to register with a major party just to have a say in the primaries), we want to hear from you!

Email *

First Name *

Last Name *

Phone (optional)

Choose which best describes you: *

Currently registered Independent/Unaffiliated

An Independent who has chosen to register as a Democrat

An Independent who has chosen to register as a Republican

An Independent who has registered with a different party (e.g. Libertarian, Green)

Other:

The Pennsylvania COUNTY where you vote *

Your address (optional)

Your age (optional)

Your gender (optional)

Your race and ethnicity (optional)

Any other info / comments you'd like to share?

Permission to contact: *

I grant permission for a member of the Ballot PA campaign to contact me about a media inquiry OR to put me directly in touch with a reporter if necessary

Required

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