2018 GEORGIA SENATE PAGE FORM

INTEREST FORM

If you are interested in being a page for the Georgia Senate, please complete this form and email it to your state Senator’s administrative assistant (directions below). All pages must be scheduled at least 1 week in advance of their requested dates; this is due to special events and coordinating with the Senator. Pages must be 12 years or older at the time of application to serve.

Student Information

First Name: Last Name:

Name as to be displayed on certificate:

Address: Street

City State Zip

School:

Grade: Date of Birth:

Please list three dates that will best fit your schedule to serve as a page.

1.) 2.) 3.)

Parent/Guardian Contact Information:

Name:

Primary Phone:

Alternate Phone:

Email Address:

I consent to the above named student to serve as page for the Georgia Senate.

Parent/Guardian Signature Date

How to apply: By visiting www.openstates.org and entering your address into the search bar you will be able to find your state Senator. Once you know your Senator’s name, visit www.senate.ga.gov and click on the Senator tab to locate your Senator’s State

Capitol Office information. Complete the 2018 Page Interest Form and save and email or print, scan and email it to your Senator’s administrative

assistant. After your interest form has been received and approved by your sponsoring Senator, you will be contacted by your Senator’s

administrative assistant confirming which of your three requested dates has been selected for you to page.

List your senator’s name and office number: