Omegas Seeking Political Office

OMEGA PSI PHI FRATERNITY, INC.
Talented Tenth District
Request for Omega Candidates Information
** Upcoming Elections 2017 and Beyond **
Please select the correct year, which the candidate is planning seek office

** Chapter the Omega is Financial or Affiliates **

The Omega Brother MUST list the chapter which he is currently financial and/or is affiliated.
Please select your correct chapter. If you chapter does not exist, please select "Other" and enter the chapter name ONLY. DO NOT add Chapter at the end NOR any chapter nicknames. (Ex. Omicron Theta)
Please enter the chapter street or PO Box address that is on file with IHQ. Make sure you capitalize the appropriate words. (ex. Main Street, Monroe Avenue, PO Box 9999)
Please enter the chapter city that is on file with IHQ. Make sure you capitalize the appropriate words. (ex. Chicago, Detroit, Minneapolis, Indianapolis, Madison)
Please enter the chapter state that is on file with IHQ. Make sure you capitalize the appropriate words. (ex. IL, IN, MI, MN, WI)
Please enter the chapter zip/postal code that is on file with IHQ. Make sure you use 5 digits or the 5 digits - 4 digits. (ex. 60681, 60681-0265)

This certifies that the member below is a bona fide member Omega Psi Phi Fraternity, Incorporated.

Please enter the brother's first name who is being credentialed. Please use the proper cases. (ex. James and NOT james)
Please enter the brother's last name who is being credentialed. Please use the proper cases. (ex. Doe and NOT doe)
Please enter the brother's control number who is being credentialed. Make sure you add the two leading zeros. (ex. 009999999)
This email address is needed for verification purposes.

OFFICE BEING SOUGHT

Please enter your campaign website URL (ex. http://johndoe4congress.com)
Facebook, Google+, Twitter, Instagram, etc.
Please put the full address and include the zip code too. (ex. 1313 Mockingbird Lane,Chicago, IL 60601)
Please put the full address and include the zip code too. (ex. 1313 Mockingbird Lane,Chicago, IL 60601)
Please put the full address and include the zip code too. (ex. 1313 Mockingbird Lane,Chicago, IL 60601)

Campaign Manager's Info:

Use this area for the Campaign Manager to gather information for possible volunteers.
Please enter the full name. (ex. Jane Doe)
Please enter the number including the area code. (ex. 773-777-9311)
Please use an email address that will be checked constantly by the Campaign Manager or by staff.

NOTE: This form will be emailed directly to the Tenth District Political Education Chair, Calvin Toone, at political_ed@omega10thdistrict.org.