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Your participation is essential to
re-electing Brian in 2006. Please check off your
interests and availability by completing the form below.
Campaigns are quite expensive and any assistance you can provide would be
greatly appreciated. Please go to our donation form to help
out.
Thank you for your interest in the campaign! |
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Contact Information |
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| Mr. or Ms. |
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| First Name |
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| Middle Initial |
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| Last
Name |
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| Street Address
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| City |
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| State & Zip
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| Daytime Phone |
Call
here first |
| Evening Phone |
Call
here first |
| Fax |
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| E-mail Address |
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| Occupation |
(optional) |
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Send me campaign updates via email |
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| Please tell us how you can help
(Check all that apply) |
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I'll campaign
door-to-door for Brian |
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I'll display a
Feldman yard sign |
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I'll host a Coffee
for Brian |
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I'll help make
telephone calls |
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I'll help with bulk
mailings |
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I'll help at the polls on Election
Day |
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I'll serve as a
Community Captain |
