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First Name	Last Name
Street No./Street Name:	Apartment/Suite Number:
City:	State/Zip
Cell Phone	Home Phone
Email
Occupation:	Employer:
Prior Campaign Experience: YesNo
Volunteer Oppurtunities: Put up a lawn sign Write a “letter to the editor” in support of Dick Support Dick in Weekly Standouts Add my name to Dick’s public list of supporters Election Day Help Invite Dick to speak to an organization I belong to Use a bumper sticker or car magnet Other