Last Name:   

First Name:

Address:  

City:   Zip Code:

Telephone Number:   Fax:

Email:

Occupation:      Age:

How do you connect to the Internet?  Dial Up          DSL          Cable          Do not have Internet

Areas of Specialized Knowledge:

Are you willing to serve as a media spokesman in your area of expertise:  Yes   No 

Are you registered to vote?:  Yes     No 

I would like to be enrolled in the following Internet groups (Be aware that, with the exception of the official progressive email the other groups listed are independent of our organization.

Official Lubbock County Progressives Email Group (used for event announcements and official business only)

Progressive Lubbock Google Group

Progressive Lubbock Google Group (Announcements Only)

Progressive Lubbock Facebook Group

Flickr Photo Sharing Group

Tweeter Progressive Lubbock Group (Announcements Only)

LinkedIn Career and Professional Business Network Site Group

Other Comments?