Name
First: Last:

Phone
Home: Work: Cell:

Address
Email: Confirm Email:

Street: City: State: Zip:

What sort of activites would you like to do to help get our candidates into office?
(Please select all that apply)

Make phone calls		Work at Voter Registration Tables		Work the Polls (hand out materials)
Prepare Mailings		Drive Voters to Polls		Plan Events & Activities
Recruit Volunteers		Hold a House Party		Post Candidate Signs
Deliver Yard Signs		Knock on Doors/ Gather Signatures		Data Entry/ Computer Work