First Name

Last Name

Email Address

Zip Code

On which campaign do you feel you made the most impact?

What did you do?

On what issue do you feel you made the most impact?

What did you do?

Are you a member of a local DFA group? If so, which one?

What was the DFA group’s biggest success?

If you were to nominate another DFA member for recognition, who would it be?

Why did you choose this person?

Have you ever attended a DFA Training? (check all that apply)
Campaign Academy Weekend
Night School

Can you give an example of how DFA Training helped you?

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