Name *

First Name

Last Name

Phone

(###)

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Involvement

If you would like to lend a helping hand select how you would like to get involved.

I will walk my neighborhood with Scott

I will host a meet and greet

I will accept a yard sign

I will send out emails to people who will sign an online petition

Use my name for endorsements

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country