The Centrist Party

User Name Enter a user name, usually something like 'jsmith'. No spaces or special characters. Usernames and passwords are case sensitive, make sure the caps lock key is not enabled. This is the name used to log in.

First Name Enter your first name.

Last Name Enter your last name.

Address 1 Enter your mailing address.

Address 2 Enter your mailing address 2nd line.

ZIP Code Enter your ZIP Code.

Telephone Number Enter your primary telephone number.

Secondary Telephone Number Enter your secondary telephone number, if desired.

Select Current or Previous Political Affiliation Select your current or previous political affiliation.

Other political affiliation If you selected 'Other' as your political affiliation, please indicate your affiliation in the space below.

E-mail Enter an email address. This is necessary in case the password is lost. We respect your privacy, and will not give the address away to any third parties or expose it anywhere.

Type the code Type the code from the picture shown below.

Registration form