Campaigner From

Activity covers the period from December 2012-May 2013 Want to be part of the campaign to bring the serious issues of election closer to the hearts and consciousness of the Filipino youth? Be a campaigner TODAY by filling out this form truthfully. All information are considered confidential and will only be assessed by the Youth for Elections Project Director and Manager. Reminders: 1. Please fill all required fields to be in the official list of Youth for Elections Campaigner. (fields with * are optional). 2. Once you've accomplished this campaigner form, please send it to youth4elections@gmail.com to be complied in the system and to be officially listed as a campaigner. 3. You will be receiving a confirmation e-mail within 48hours if your application was accepted or temporarily on hold for certain reasons (possible holding reasons are listed below this form). 4. If you do not receive any confirmation e-mail within 48 hours, it automatically means the system did not receive your filed campaigner form. Please resend the form until you receive a confirmation e-mail. 5. You will be asked to reply a certain code for further verification. 6. If you have successfully entered the right code, you will be receiving a campaigner I.D./Card within 24hours as your proof that you're officially part of the Youth for Elections campaign. (the campaign manager can now easily tap you for help and support in future projects of Youth for Elections project/campaign).

------------------------------------------------------------------------------------------------------------------Campaigner Form Last name: __________________________ First name: ___________________ M.I. _____ Age: ___ *Civil Status: ______________ Year of birth: __________ Sex: ( )F ( )M Profession: ( )Highschool Student ( )College Student ( )Teacher/Professor ( ) Others: ____________________ School/Institution/Organization: __________________________________________________ Are you a registered voter? ( ) Yes ( )No Reason/s for joining: ___________________________________________________________ Preferred E-mail address: ________________________________________________________ *Mobile number: __________________________ Campaigner name: _____________________________________________________________
(to be printed in your campaigner I.D./Card, Code name/Username is accepted)

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Reasons for application to be on hold status:

1. Not all required fields are accomplished

Campaigner From
Activity covers the period from December 2012-May 2013
2. Inconsistencies in the information given

Thank you for your interest! May this campaign spread among the Filipino Youth with the interest and support you are showing by accomplishing this Campaigner Form. From, Youth for Elections Project Director and Manager