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First Name:	Last Name:
Email:
Mobile Phone:	Home Phone:
Street Address:
City: State: Zip: State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Make phone calls to my friends and neighbors.
Display a lawn sign in my yard.
Write a letter to the editor.
Walk with you at a parade or community event.
Hand out literature door-to-door.
Additional Comments: