| Your information: |
| Name*: |
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| Phone Number*: |
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| Address*: |
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| City/Town*: |
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| State*: |
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| Zip*: |
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| E-mail*: |
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| I would like to help in the following ways: |
| Put up a lawn sign |
Make phone calls |
| Display bumpersticker |
Host a coffee/house party |
| Help with mailings |
Help on Election Day |
| Do a neighborhood walk |
Hold signs at visibility events |
| Write "Dear Friend" cards |
Canvass neighborhoods |
| Host a fundraiser |
Serve as neighborhood contact or precinct captain |
Other:
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