Register - Florida Institute for Political Leadership

Choose Your School *

Part 1: Your Information

First Name *

Last Name *

Home Address *

Address Line 2

Layout

City *

State *

Zip Code *

Layout

Cell Phone *

Office Phone

Email Address *

Facebook

Twitter

Instagram

Personal Website

Part 2: Your Goals

Are you currently an elected official, candidate for elected office, or thinking about running for office? *

Current Elected Position/Title:

Why are you serving in public office?

What are the top issues you are passionate about?

What is one guiding principle or core value of yours?

I am a candidate for the office of

What boards or elected offices are you considering?

What is one guiding principle or core value of yours?

What are the top issues you are passionate about?

Have you sought elected office before? *

If yes, Which office did you seek?

Are you interested in working for or volunteering on a campaign?

If yes, what type of work can you provide to a campaign?

Part 3: More About You

How did you hear about this program?

Are you a member of your local Chamber of Commerce?

Yes
No

Current Community Involvement

What is your current occupation?

Employer

Company Website

What is your age?

Highest Level of Education

What is your race or ethnicity?

Party Affiliation *

In general, how would you describe your views on most FISCAL issues?

Very Liberal	Liberal	Moderate	Conservative	Very Conservative
Very LiberalVery Liberal	LiberalLiberal	ModerateModerate	ConservativeConservative	Very ConservativeVery Conservative

In general, how would you describe your views on most SOCIAL issues?

Very Liberal	Liberal	Moderate	Conservative	Very Conservative
Very LiberalVery Liberal	LiberalLiberal	ModerateModerate	ConservativeConservative	Very ConservativeVery Conservative

Checkboxes *

I understand that the Florida Institute for Political Leadership school is free to attend. As an elected official or a candidate who has qualified to run for office, I will be required to pay a nominal fee to attend the class in accordance with Florida Election Law.