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First Name *
First Name * :: Required - Please enter First Name
Last Name *
Last Name * :: Required - Please enter last name
Email Address *
Email Address * :: Required - Please enter valid Email Address
The following fields are optional, but will be helpful to us
Address
Address :: Please enter your street address or post office box
City
City :: Please enter City
State
State :: Please enter State
Zip Code
Zip Code :: Please enter 5 digit Zip Code
Cell Phone
Cell Phone :: Please enter Cellphone Number
Home Phone
Home Phone :: Please enter Home Phone Number
Work Phone
Work Phone :: Please enter Work Phone Number
Volunteer Activities * (Please select at least one)
Please select one or more volunteer activities
Host a coffee, fundraiser, or other event
Walk neighborhoods (block walk)
Make phone calls to voters
Help with mailings (stuff and address envelopes)
Staff tables at events
Deliver and install yard signs
Distribute fliers
Contact me for anything else that comes up
Other - Please specify in box below
Please select one or more volunteer activities :: Please select one or more volunteer activities
Other - Here's what I would like to do
Other - Here's what I would like to do :: Please enter - what you would like to do