Ellen Jaffee For New York State Assembly 95th District

Ellen Jaffee For New York State Assembly 95th AD
Campaign Volunteer Form

(Please print)
Name __________________________________ Email________________________

Address _____________________________________________________________

Phone (home)____________________ (work/cell)__________________________

I can help in the following ways: (please check one or more)

    [  ] Please include me in your published list of supporters.

    [  ] phone banks

    [  ] staff headquarters

    [  ] distributing campaign literature

    [  ] post a lawn sign at my house

    [  ] walk my neighborhood with you and /or hosting a house party

    [  ] sending postcards/letters to friends in support of Ellen

    [  ] fundraising

    [  ] Coordinating one of these efforts__________________________

    [  ] something else (you name it) ____________________________________

I am most available on (days/hours): _________________________________

On Democratic Primary Election Day (Tuesday, Sep 12), I can help get out the vote by:

[  ] telephoning [  ] providing transportation to polls

[  ] handing out flyers [  ] poll watcher

On Election Day (Nov. 7), I can help get out the vote by:

[  ] telephoning [  ] providing transportation to polls

[  ] handing out flyers [  ] poll watcher

I have enclosed a contribution (payable to Friends of Ellen Jaffee) of $ ________
If you wish to contribute by credit card go to: www.ellenjaffee.com

Please mail or fax to: Friends of Ellen Jaffee, 16 Lancaster Drive, Suffern, NY 10901

Fax: 845-357-4024
Contributions to political campaigns are not tax deductible - Paid for by Friends of Ellen Jaffee

[ ] telephoning	[ ] providing transportation to polls
[ ] handing out flyers	[ ] poll watcher