If you are interested in becoming a candidate for the Libertarian Party, please fill out the inquiry form below. The appropriate office will contact you.

Note: Please fill in information as completely as possible.

Name:
Address line 1:
Address line 2:
City:
State:
Zip Code:
Home Phone # :
Work Phone # :
County:	Choose a County Alcona Alger Allegan Alpena Antrim Arenac Baraga Barry Bay Benzie Berrien Berrien Branch Calhoun Cass Charlevoix Cheboygan Chippewa Clare Clinton Crawford Delta Dickinson Eaton Emmet Genessee Gladwin Gogebic Grand Traverse Gratiot Hillsdale Houghton Huron Ingham Ionia Iosco Iron Isabella Jackson Kalamazoo Kalkaska Kent Keweenaw Lake Lapeer Leelanau Lenawee Livingston Luce Mackinac Macomb Manistee Marquette Mason Mecosta Menominee Midland Missaukee Monroe Montcalm Montmorency Muskegon Newaygo Oakland Oceana Ogemaw Ontonagon Osceola Oscoda Otsego Ottawa Presque Isle Roscommon Saginaw Saint Clair Saint Joseph Sanilac Schoolcraft Shiawassee Tuscola Van Buren Washtenaw Wayne Wexford Outside Michigan
E-Mail address (required):

Date of Birth
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Your Occupation


Your Employer



Are you registered to vote in your state?
Yes    No

If YES, what is your official party registration?
Libertarian
Republican
Democrat
Independent
Other, please specify:
No official party registration

Have you changed your official party registration in the past two years?
Yes    No
(Some states require candidates to maintain Libertarian Party registration for a certain number of years)

If YES, please specify details below:



Have you ever run as a Libertarian Party candidate for public office before?
(NOTE: this question does not apply to candidacy for Libertarian Party office, only publicly elected candidacies)
Yes    No

If YES, please specify:
   Position sought
   Election year
Election results:
  %        Number of votes
Were you elected to this office?
Yes    No

Please use the space below to specify details of any other previous candidacies for public office:



Please give us the details of the public office you are currently seeking:


Office sought

If you are not seeking a particular public office at this time, or if you aren't sure of the position, please use the space below to give us any details regarding your plans for candidacy or your interests in running for public office:




Please enter any additional questions or comments below:


   

Please note: It is most unlikely that you will experience any problems responding to this form. If you experience any difficulties you may email your response to this form to: webmaster@lpmich.org.