LWV of New Jersey Moderator Request Form

To request a League moderator for a Candidates’ Forum, please complete this form and return to contact@lwvnj.org or LWVNJ, 204 West State Street, Trenton, NJ 08608.

Contact information for person making this request (please write legibly):

Name ___________________________________________________________________

Organization ___________________________________________________________

E-mail _________________________________________________________________

Phone _____________________________________________

Elective office sought _________________________________________________

Election date ___________________

List Candidates, with contact info and Party (if applicable). Use additional space if needed.

1. ________________________________________________________________________________________

2. ________________________________________________________________________________________

3. ________________________________________________________________________________________

4. ________________________________________________________________________________________

Have all candidates been contacted and agreed to participate? _____ Yes _____ No

If No, reason(s):

__________________________________________________________________________________________

__________________________________________________________________________________________

(No “empty chair” debates – if the election is partisan, both sides must be represented; if a candidate is unable to attend, she/he may provide a brief statement to be read by the Moderator.)

For the debate, have you obtained a date? ____ No ____ Yes, the date is______________________

Have you obtained a location, such as school, town hall or other public facility? _____ No _____ Yes

The location is _________________________________________________________________________________