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Libertarian Youth Caucus
Member Registration Form
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What is your name?
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Your answer
What is your birthday?
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Where do you live? (state and city preferred)
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Your answer
Are you in school?
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Yes, College/University
Yes Trade School
Yes, High School
Yes Middle School
No
Other:
If you are in school, what is its name?
Your answer
What is your phone number?
Your answer
What is your email?
*
Your answer
What is your facebook page?
Your answer
Would you like to be added to our Facebook group?
*
Yes
No
Are you a Libertarian Party member?
Yes, I am a member of the national and state parties
Yes, I am only a member of the national party
Yes, I am only a member of the state party
No, I am not a member of either party
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What other libertarian or liberty minded groups or clubs are you a part of?
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Your answer
Would you be interested in serving in LYC leadership?
Yes
No
Maybe in the future
Yes, I would like to form a campus or local affiliate
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