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Your participation is essential to
re-electing Brian in 2010. Please check off your
interests and availability by completing the form below.
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 |
