Al Stirpe - Assembly District 127 |Assembly Member Directory

Hello! Thank you for completing the AD 127 Constituent Survey

All nominees must reside in the 127th Assembly District, which includes the Towns of Clay, Cicero, Manlius, and Cazenovia!
Nominations must be received by Monday, March 2nd
Awards ceremony will be held on Saturday, March 21st at 10:30 a.m. at the Fayetteville Fire Station Community Room 425 East Genesee St., Fayetteville, NY 13066

1. Name of person submitting nomination:

Title

First Name

Middle Initial

Last Name

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2. Address of person submitting nomination:

Apt Number

City

State

Zip

3. Telephone number of person submitting nomination:

4. Email address of person submitting nomination:

Confirm Email:

5. Name of woman being nominated:

Title

First Name

Middle Initial

Last Name

Suffix

6. Address of woman being nominated:

Apt Number

City

State

Zip

7. Telephone number of woman being nominated:

8. Email address of woman being nominated:

Confirm Email:

9. I wish to nominate the above-named woman for Assemblyman Al Stirpe’s Women of Distinction Award in the following category:

Business/Entrepreneurship

Community service

Education

Military service

Health care

10. Biography of woman being nominated:

User Name