Contact Information First Name Last Name Job Title Birth Date MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year19251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025 Year Street Address City Postal Code Country United StatesCanadaUnited Kingdom State/Province District/County Phone Number Email I am a military veteran. Yes No Yes, I would like to receive WFAN News via email. Yes No Yes, I would like to receive Plate to Politics emails. Yes No Survey Questions How would you describe the area in which you live? - None -RuralSuburbanMetro/Urban Are you interested in attending an in-person training to expand your leadership skills and networks? Yes No What formats help you learn? In-person workshop Webinars Group video chat eBook Check as many as apply. Other (please describe) What policies do you care about? Please describe policy changes you would like to see that impact sustainable agriculture and organic food policies in the US. What do you need to help advance your leadership on these issues? How can we help you? Are you interested in helping identify and/or support women candidates who are sustainable agriculture and organic food champions? Yes No What is your current involvement? What are the biggest factors you must weigh before deciding to run for office? Income, changing careers or working and serving Determining care for children, households, aging parents, etc. Afraid of raising money Fitting it into an already busy life Figuring out what issues to tackle in a campaign Deciding what office to run for Please select your TOP 3. * What scares you most about running for political office? Losing the campaign Fundraising, campaigning, public speaking Family and friends will be subject to scrutiny Things in my past will be brought up The confrontation with others My qualifications being questioned Managing it all (farm, work, family, public service) (Select your top 3 fears) Are you currently... Holding public office or position of influence (i.e. boards and commissions) Considering running for appointed or elective office Planning to run for office Other Submit
