Candidate Information

Note: Fields marked with an * are required.

Please complete the form fields below.

Candidate Name

Candidate is running for: *

Election Year *

Are you Pro-Life?

Yes No Undecided

Are there any additional comments you would like to make about the issue of abortion:

Point of Contact Name: *

Point of Contact Information (email preferred)

phone number or email address

Campaign Address Information

If Huck PAC endorses your campaign, what is the maximum amount that can be given to your campaign from our PAC: