Name:
Age:
Home state:
Fun
Dangerous
Hyper
Gross
What gender do you identify as?
Male
Female
Non-binary
Prefer not to say
Which of the following applies to you?
I care about being politically active
I am unsatisfied with the current state of politics in America
I am unsatisfied with my political party
I am willing to make a change
What changes do you want to see made in America:
Email:
Phone:
