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Date: _______ / ________
/ ________
Steve,
I agree that it's time to break new ground. I'd like to
help with your race for Commissioner of
Agriculture.
____ I will register to vote and
vote. (Remember I'm running as a Republican.)
My donation for
enclosed (Personal checks only, no cash or business checks):
___$4000 ___$2000 ___$1000 ___$500 ___$250
___$100 ___$50
___$10 ___$5 ______Other
I would also like to help
by:
___ Serving
on your campaign committee.
___ Distributing
campaign literature or manning an election site.
___ Displaying
your posters and putting a bumper sticker on my car.
___ I
will hold a fundraiser, organize rallies, or meet the candidate
activities.
___ Other
_______________________________________________(Please
Specify).
| Signature: |
__________________________________________________________ |
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| Printed
Name: |
__________________________________________________________ |
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| Employer: |
__________________________________________________________ |
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| Occupation: |
__________________________________________________________ |
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| Address: |
__________________________________________________________ |
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| City: |
__________________________________________________________ |
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| State: |
______________________ |
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| Zip
Code: |
______________________ |
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| Phone
Number: |
( ___ ) ____ - __________ |
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| E-Mail
Address: |
__________________________________________________________ |
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