First Name
Last Name
Address
City
State
Zip
Phone Number
Gender
Comments
E-Mail
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Activities
I'd like to be involved in:
Placing phone calls
Being a precinct captain
Volunteering at the campaign office
Placing a sign in my yard
Walking door to door
Sending a letter to the editor
Hosting a reception or coffee
Sending email messages to my friends
Helping with fundraising
Placing a bumper sticker on my car
Permitting my name to be used in endorsements
Calling in to a radio show
Other (please specify)
I am interested in the following issues:
Please check all that apply
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