Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

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How I Can Help the Campaign

Choose all that Apply:

Making Phone Calls

Public Endorsement (Name on Literature/Social Media)

Donating to the Campaign

Fundraising from Others

Hosting/Organizing a Campaign Event

Knocking on Doors

Posting about the Campaign on Social Media

Place a Yard Sign in My Yard