Senate District Number:

Senate Candidate (Democrat):

Name of Staff Person Surveyed:

Position of Support:
    Favorable    Unfavorable    Undecided    Refuses to Answer

Requested More Information?  
    Yes    No
    If yes, 
        Fax number:
        Email:

Additional Comments:
   

Senate Candidate (Republican):

Name of Staff Person Surveyed:

Position of Support:
    Favorable    Unfavorable    Undecided    Refuses to Answer

Requested More Information?  
    Yes    No
    If yes, 
        Fax number:
        Email:

Additional Comments:
   

Senate Candidate (Other):

Name of Staff Person Surveyed:

Position of Support:
    Favorable    Unfavorable    Undecided    Refuses to Answer

Requested More Information?  
    Yes    No
    If yes, 
        Fax number:
        Email:

Additional Comments:
   

House District Number:

House Candidate (Democrat):

Name of Staff Person Surveyed:

Position of Support:
    Favorable    Unfavorable    Undecided    Refuses to Answer

Requested More Information?  
    Yes    No
    If yes, 
        Fax number:
        Email:

Additional Comments:
   

House Candidate (Republican):

Name of Staff Person Surveyed:

Position of Support:
    Favorable    Unfavorable    Undecided    Refuses to Answer

Requested More Information?  
    Yes    No
    If yes, 
        Fax number:
        Email:

Additional Comments:
   

House Candidate (Other):

Name of Staff Person Surveyed:

Position of Support:
    Favorable    Unfavorable    Undecided    Refuses to Answer

Requested More Information?  
    Yes    No
    If yes, 
        Fax number:
        Email:

Additional Comments:
   

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