Register below to become a Precinct Caucus Captain for the Partnership to Fight Chronic Disease and Partnership for Better Health (PFCD/PBH).
 
As a Precinct Caucus Captain, you will submit the PFCD/PBH party-neutral resolution at your local precinct caucus.		 Together, we will propel the objective of chronic disease prevention into spotlight and onto the state platforms of Iowa's Republican AND Democratic Parties!
 
For more info on the fight against chronic disease, visit FightChronicDisease.org and PartnershipForBetterHealth.org.
Please complete the following form if you would like to submit the PFCD/PBH chronic disease resolution at your local Democratic precinct caucus. Within one week of submission, we will mail or e-mail you with further instructions, including the date and location of your Democratic precinct caucus.

PARTY AFFILIATION
Democrat:  Republican:

CONTACT INFORMATION
 * Required field
 Full Name:   *
Address Line 1:   *
Address Line 2: 
City:   *  State:   *
Zip Code:   *
Daytime Phone: 
E-mail:  

ADDITIONAL INVOLVEMENT
By submitting this form, you are only consenting to submit the PFCD/PBH chronic disease resolution at your precinct caucus. If you are interested in being contacted for further involvement, please check any of the following boxes:

Send a letter to a newspaper.
 Show support at a presidential campaign visit.
 Host a PFCD speaker at a local event.
 Speak on behalf of the PFCD.
 Nothing right now, but I'd like to learn more.
 

All information is confidential and will be used only in execution of the PFCD/PBH effort. None of your personal information will be sold or given to any organization or third party. Thank you for your support!
Please complete the following form if you would like to submit the PFCD/PBH chronic disease resolution at your local Republican precinct caucus. Within one week of submission, we will mail or e-mail you with further instructions, including the date and location of your Republican precinct caucus.

PARTY AFFILIATION
Democrat:  Republican:

CONTACT INFORMATION
 * Required field
 Full Name:   *
Address Line 1:   *
Address Line 2: 
City:   *  State:   *
Zip Code:   *
Daytime Phone: 
E-mail:  

ADDITIONAL INVOLVEMENT
By submitting this form, you are only consenting to submit the PFCD/PBH chronic disease resolution at your precinct caucus. If you are interested in being contacted for further involvement, please check any of the following boxes:

Send a letter to a newspaper.
 Show support at a presidential campaign visit.
 Host a PFCD speaker at a local event.
 Speak on behalf of the PFCD.
 Nothing right now, but I'd like to learn more.
 

All information is confidential and will be used only in execution of the PFCD/PBH effort. None of your personal information will be sold or given to any organization or third party. Thank you for your support!

Copyright © 2007 PFCD. PBH logo used with permission. All rights reserved.