Questions? Comments?

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Name (first, last):

Major:

Year:

Zip code in which you are registered to vote:

Phone:

Email:


Level of participation:
Team Leader
Logistical Coordination of Event
Participant
On-campus Organizer

How did you hear about Cal Lobby Day?
Friend
Flyers
Web
Class Announcement
Other

Are you on Financial Aid?
Yes
No

Please list up to four other people who you would like to be in a lobby group with: