First Name        
Last Name        
Shirt Size       
Mailing Address  
Apartment        
City             
State             
Zip Code         
Daytime Phone    
Evening Phone              
Fax?                             
E-Mail?          
Organizations?   

I am willing to (check all that apply):

   Put a Baldwin Sign in my yard or business
   Help out at Headquarters
   Distribute campaign material 
   Help translate materials for the campaign
   Host a fundraiser for the campaign
   Help the campaign in other ways as necessary