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Your participation is essential to our victory in 2006. Please check off your
interests and availability by completing the form below.
Campaigns are quite expensive and any assistance you can provide would be
greatly appreciated. Please go to our donation form to help
out.
Thank you for your interest in the campaign! |
| Contact Information |
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| Mr. or Ms. |
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| First Name |
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| Middle Initial |
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| Last
Name |
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| Street Address
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| City |
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| State & Zip
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| Daytime Phone |
Call
here first |
| Evening Phone |
Call
here first |
| Mobile Phone |
Call
here first |
| Fax |
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| E-mail Address |
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| Occupation |
(optional) |
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Send me campaign updates via email |
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| Please tell us how you can help (Check all that apply) |
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I'll help with door to door |
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I'll help with
Teas and Receptions |
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I'll display a
Lawn or window sign |
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I'll help with mailings and HQ work |
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I'll wave at
street corners/shopping centers |
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I'll help at the polls on Election
Day |
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You can list my name as a supporter |
