Name: |
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Address: |
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Postal Code: |
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Home Phone: |
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Work Phone: |
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Cell Phone: |
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Email: |
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Are you a Party Member? |
Yes No |
Will you take a sign? |
Yes No |
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What volunteer tasks would you like to do? |
Drop leaflets door to door |
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Canvass door to door (talk with voters) |
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Canvass with Peggy |
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Phone volunteers |
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Canvass by phone (talk with voters) |
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Work in the campaign office |
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Other |
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Do you have a valid driver's license? |
Yes No |
Do you have access to a car / truck / van? |
Yes No |
Do you have a PC computer at home? |
Yes No |
Are you comfortable with: |
Email Word Excel Filemaker Pro other program: |
Do you speak any langauges other than English? |
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Have you made a donation to our campaign? |
Yes No |
Are you planning to make a donation to our campaign? |
Yes No |
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Please add any additional notes:: |
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