Green Party Survey
Firstname:
Lastname:
Email:
Phone Number:
Age:
Today's Date:
Did you vote in the last election?
Yes
Are you voting in the next election?
Yes
Which Political Party are you?
Democrat
Republican
Green Party
Libertarian
other
Choose an amount to donate to the green party
$10
$20
$50
$100
$500
Describe the causes you care most about in the green party:
One last question, what shade of green is your favorite?
