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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.

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Republican National Committee

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Washington, D.C. 20003

p 202.863.8500 | f 202.863.8820

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

©2009 Copyright Republican National Committee