The Liberian Community Association

(Dallas/Fort Worth, Texas)

General Election 2011

Application For Candidacy

Deadline for This Application is July 10, 2011

Please fill out this form completely. All required fields () MUST be filled out as requested or you will not be able to submit the form. After entering all the required information, click the SUBMIT BUTTON at the end of the document to send your form. If you need to change your information and start over, click the RESET BUTTON. The form will clear and you can enter new information. For help, call Dr. David (682) 551-4629. Thank you. Help make the Liberian Community Association a viable Organization*
First Name	*
Last Name	*
Salutation	*
Gender	*
Ethnicity	*
Nationality	*
Length of stay in Texas	*
Position
Education
Title

Phone	*
E-mail	*
Presidential Candidate Only (Clearly state in 150-200 words why you should be considered for this position).

Thank you for supporting nonviolent change in Liberia.