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Endorsement/Volunteer/Contribution Form

Yes, Maxine! I endorse your candidacy and will help elect you to be our next 78th Assembly District representative.
First Name:
Last Name:
Address:
City:
State:
Zip:
Phone:
Email:

I would like to volunteer and you can count on me to (check all that apply):
	Make telephone calls	Host a small gathering at my home
	Work in the campaign office	Distribute literature in my Neighborhood
	Post a sign at my home or business	Host a fundraiser
	Walk a precinct	Invite Maxine to meeting(s) or event(s)

	I would like to make a contribution:

$3,600.00

$2,000.00

$1,000.00

$500

$250

$100

Other $

State law limits individual campaign contributions to $3,300.00 per election cycle. Contributions are not decuctible for income tax purposes. State law permits individual, business and PAC contributions.
Paid for by Maxine Sherard for State Assembly.

The following information is required by law for contributions of $100 or more.
Full Name:
Home Address:
City:
State:
Zip:
Home Phone:
Occupation:
Employer
Business Address:
City:
State:
Zip:
Business Phone: