PSA Constituency Development Online Registration

Please enter your contact information below to register for
the PSA Constituency Development Program.
 

All information provided on this form will be held in strict confidence by PSA. You will not be contacted for donations to Clemson using this information and we will not sell or share this information with outside parties. We will use this information to contact you regarding issues in the legislature that may affect PSA services and programs.

PERSONAL INFORMATION

Last, First

Preferred

Mailing Address
    

City, Zip

State

Phone

Alternate Phone

Email

GOVERNMENTAL INFORMATION

Elected Official 1

Elected Official 2

Postion

Position

Relationship

Relationship

Campaign Involvement

Campaign Involvement

Elected Official 3

Elected Official 4

Postion

Position

Relationship

Relationship

Campaign Involvement

Campaign Involvement

PLEASE CHECK AREAS YOU FEEL MOST QUALIFIED OR INTERESTED IN.
CHECK AS MANY AREAS AS YOU WISH.

 

PSA General

"Your Day" Radio Program

Agricultural Research

"Making it Grow" TV Program

Cooperative Extension Service

"Expeditions" TV Program

Livestock-Poultry Health

4-H

Regulatory Services

Master Gardeners 

FFA

Other

Other Desc:

 

You may cancel your registration at any time by sending an e-mail to PSA Advocacy with the word "unsubscribe" in the subject line.