1. Would you like to Volunteer:

   
   Walk Neighborhoods
   Make Phone Calls
   Work at Campaign Headquarters
   
   

   Would you like any Campaign Signs?:

   ---- Small Sign Large Sign Extra Large Sign

   If Yes How Many ?

   
   

   Please provide the following contact information:

   Name
   Street Address
   Address (cont.)
   City
   State/Province
   Zip/Postal Code
   Work Phone
   Home Phone
   FAX
   E-mail

   Is there Anything Else we can help you with?

    

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