Faces Submission Form Template - Republican National Committee

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Faces Submission Form Template

GOP Faces Information Form

We are working on a special project to showcase the faces of the Republican Party – YOUR faces. Would you like the opportunity to be represented on our new website? Just submit a picture of yourself with your answer to “I’m a Republican because…” in 128 characters or less.

* required information


Please fill out the following information
GOP Faces Photo:*	Click here to attach file
I am a Republican Because (128 characters):*
First Name:*
Middle Initial:
Last Name:*
Email:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Phone:
Company Name:
Job Title:
Twitter Login:
Show Twitter Name:	Yes No
Facebook User Name:
Show Facebook Name:	Yes No
Blog URL:
Show Blog URL?:	Yes No
I authorize the GOP to use my image and content for any marketing materials.:*	Yes

Legal Notice: By submitting this form, you understand that any Content, including images and comments, submitted for the purposes of GOP Faces may be used at the sole discretion of the Republican National Committee (“RNC”), and the RNC shall not be liable for any use or disclosure of any such Content.

Paid for by the Republican National Committee.
Not Authorized By Any Candidate Or Candidate's Committee
www.gop.com

Republican National Committee

310 First Street, SE
Washington, D.C. 20003

info@gop.com

p 202.863.8500 | f 202.863.8820

Links

Paid for by the Republican National Committee
Not Authorized By Any Candidate Or Candidate's Committee
www.GOP.com