| First
Name: * |
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| Last
Name: * |
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| Email: * |
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| Address
Street 1: |
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| Address
Street 2: |
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| City: |
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| Zip
Code: |
(5 digits) |
| State: |
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| Daytime
Phone: |
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| Evening
Phone: |
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Host a fund raising event
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| Host a neighborhood party/coffee |
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| Request/Display bumper sticker |
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Request/Display a yard sign
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Use my name in an endorsement ad
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Canvass my neighborhood/precinct
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Email my colleagues and friends
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Send letters/post cards to my friends
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Make phone calls to get out the vote
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Volunteer in the campaign office
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Make Contribution
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| Other |
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