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             	<div class="chapterCaption">
	        	<h1>Chapter Officers</h1>
	          	<table width="250px">
			  <tr><th>Name</th><th>Office</th></tr>
				
			   		<tr>
						<td nowrap>Kori Rempfer</td>
                                                <td nowrap><b>President</b></td>
					</tr>
		        	
			   		<tr>
						<td nowrap>Susan Fruth</td>
                                                <td nowrap><b>National Committeewoman</b></td>
					</tr>
		        	
			   		<tr>
						<td nowrap> </td>
                                                <td nowrap><b>National Committeeman</b></td>
					</tr>
		        	
	      		</table>
		</div>
        <br />State: IL
	<h1>*IL - Young Democrats of Illinois</h1>


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<label for="f31">State/Province</label>
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  <option value="AL" >Alabama</option>
  <option value="AK" >Alaska</option>
	<option value="AS" >American Samoa</option>
	<option value="AZ" >Arizona</option>
	<option value="AR" >Arkansas</option>
	<option value="CA" >California</option>
	<option value="CO" >Colorado</option>
	<option value="CT" >Connecticut</option>
	<option value="DE" >Delaware</option>
	<option value="DC" >D.C.</option>
	<option value="FL" >Florida</option>
	<option value="GA" >Georgia</option>
	<option value="GU" >Guam</option>
	<option value="HI" >Hawaii</option>
	<option value="ID" >Idaho</option>
	<option value="IL" >Illinois</option>
	<option value="IN" >Indiana</option>
	<option value="IA" >Iowa</option>
	<option value="KS" >Kansas</option>
	<option value="KY" >Kentucky</option>
	<option value="LA" >Louisiana</option>
	<option value="ME" >Maine</option>
	<option value="MD" >Maryland</option>
	<option value="MA" >Massachusetts</option>
	<option value="MI" >Michigan</option>
	<option value="MN" >Minnesota</option>
	<option value="MS" >Mississippi</option>
	<option value="MO" >Missouri</option>
	<option value="MT" >Montana</option>
	<option value="NE" >Nebraska</option>
	<option value="NV" >Nevada</option>
	<option value="NH" >New Hampshire</option>
	<option value="NJ" >New Jersey</option>
	<option value="NM" >New Mexico</option>
	<option value="NY" >New York</option>
	<option value="NC" >North Carolina</option>
	<option value="ND" >North Dakota</option>
	<option value="MP" >Northern Mariana Islands</option>
	<option value="OH" >Ohio</option>
	<option value="OK" >Oklahoma</option>
	<option value="OR" >Oregon</option>
	<option value="PA" >Pennsylvania</option>
	<option value="PR" >Puerto Rico</option>
	<option value="RI" >Rhode Island</option>
	<option value="SC" >South Carolina</option>
	<option value="SD" >South Dakota</option>
	<option value="TN" >Tennessee</option>
	<option value="TX" >Texas</option>
	<option value="UT" >Utah</option>
	<option value="VT" >Vermont</option>
	<option value="VI" >Virgin Islands</option>
	<option value="VA" >Virginia</option>
	<option value="WA" >Washington</option>
	<option value="WV" >West Virginia</option>
	<option value="WI" >Wisconsin</option>
	<option value="WY" >Wyoming</option>
        <option value="AA" >Armed Forces (the) Americas</option>
        <option value="AE" >Armed Forces Europe</option>
        <option value="AP" >Armed Forces Pacific</option>
	<option value="AB" >Alberta</option>
	<option value="BC" >British Columbia</option>
	<option value="MB" >Manitoba</option>
	<option value="NF" >Newfoundland</option>
	<option value="NB" >New Brunswick</option>
	<option value="NS" >Nova Scotia</option>
	<option value="NT" >Northwest Territories</option>
	<option value="NU" >Nunavut</option>
	<option value="ON" >Ontario</option>
	<option value="PE" >Prince Edward Island</option>
	<option value="QC" >Quebec</option>
	<option value="SK" >Saskatchewan</option>
	<option value="YT" >Yukon Territory</option>
	<option value="ot" >Other</option>
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<label for="f32">Zip/Postal Code<span class='required'>*</span></label>
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	<h1><h3>I am interested in helping the Young Democrats by ...<br><span style="FONT-WEIGHT: 400; FONT-STYLE: italic"><font size="2">check all that 
apply</font></span></h3>

<div class="diaFields">

<div><input type="checkbox" value="1" name="BOOL6">Blogging</div>
<div><input type="checkbox" value="1" name="BOOL7">Door-to-Door Voter Contact<br><input type="checkbox" value="1" name="BOOL3">Fundraising<br><input type="checkbox" value="1" name="BOOL8">Hosting a 
House Party</div>
<div><input type="checkbox" value="1" name="BOOL9">Online Organizing<br><input type="checkbox" value="1" name="BOOL5">Phone 
Banking</div>
<div><input type="checkbox" value="1" name="BOOL10">Registering Voters</div>

<div><input type="checkbox" value="1" name="BOOL11">Street Team Voter Contact</div>
<div><input type="checkbox" value="1" name="BOOL12">Volunteer Recruitment</div>
<div><input type="checkbox" value="1" name="BOOL13">Volunteering on Election Day</div>
<div><input type="checkbox" value="1" name="BOOL14">Website Design</div>
<div><input type="checkbox" value="1" name="BOOL15">Writing Letters to the 
Media</div>
</div>

<h3>I am interested in the following YDA Official Caucuses ...<br>

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<span style="FONT-WEIGHT: 400; FONT-STYLE: italic"><font size="2">check all that apply</font></span></h3>
<div><input type="checkbox" value="College Caucus" name="tag">College Caucus</div>
<div><input type="checkbox" value="Disability Issues Caucus" name="tag">Disability 
Issues Caucus</div>
<div><input type="checkbox" value="High School Caucus" name="tag">High School 
Caucus</div>
<div><input type="checkbox" value="Jewish Caucus" name="tag">Jewish Caucus</div>
<div><input type="checkbox" value="Labor Caucus" name="tag">Labor Caucus</div>
<div><input type="checkbox" value="LGBT Caucus" name="tag">LGBT Caucus</div>
<div><input type="checkbox" value="Minority Caucus" name="tag">Minority Caucus</div>
<div><input type="checkbox" value="Rural Caucus" name="tag">Rural Caucus</div>

<div><input type="checkbox" value="Veterans Caucus" name="tag">Veterans & Military Affairs Caucus</div>
<div><input type="checkbox" value="Womens Caucus" name="tag">Womens 
Caucus</div>
</h1>
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