JeffWagener.com Volunteer

		for State Representative - 85th District Integrity • Ability • Commitment

Get voter forms and information	In a race this important, the efforts of every volunteer make a big difference. Your participation could well determine how well we preserve our neighborhoods and protect our families in the next decade. Please do whatever you can to help us achieve victory in the Primary on August 3, 2004 and in the General election on November 2, 2004. If you can display a Jeff Wagener yard sign or bumper sticker, please fill in the request form below. If you'd like to take a more active role, please be sure to check off your interests and availability as you fill out the form. Feel free to add comments about yourself, including your special skills, experience, and anything else you'd like us to know. Thank you for your interest and support. Informed and involved citizens like you will be the margin of victory on November 2nd!
	Contact Information

	Mr. or Ms.
	First Name
	Middle Initial
	Last Name
	Street Address

	City
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	Daytime Phone	Call here first? Yes No
	Evening Phone	Call here first? Yes No
	Pager or Cellular	Call here first? Yes No
	Fax
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	Occupation	(optional)

	Yes No I want to receive campaign updates via email

	Yes No Updating your information? Select here if you are using this form to change your e-mail address, phone, or street address from what we currently have on file.

	Please tell us how you can help (Select all that apply)

	Yes No I'll vote for Jeff Wagener on November 2, 2004
	Yes No I'll talk to friends and neighbors about Jeff Wagener
	Yes No I'll take a Jeff Wagener yard sign for my front lawn
	Yes No I'll do phoning for Jeff Wagener
	Yes No I'll help with mailings
	Yes No I'll attend a Jeff Wagener rally in my area
	Yes No I'll distribute flyers in my neighborhood
	Yes No I'll do volunteer work at campaign headquarters
	Yes No I'll help at the polls on Election Day
	Yes No I'll serve as a block captain for the campaign
	Yes No I'll serve on a speaker's bureau

Availability
Yes No Mornings	Yes No Afternoons	Yes No Evenings
Yes No Saturdays	Yes No Sundays	Yes No Flexible

			Please tell us a little about yourself

			Yes No I have worked on a campaign before
			Yes No I am self-employed
			Yes No I am a student
			Yes No I am retired
			Yes No I am a member of a labor union
			Yes No I want information on registering to vote
				How did you hear about this campaign website?



			We'd like to hear about your special skills or interests

			Thanks for your support! You can also help out by making a donation to the campaign.

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Contributions to Jeff Wagener are not tax deductible. Paid for by Citizens to Elect Jeff Wagener,
Marlene Treadway, Treasurer, 607 Sappington Barracks Rd., St. Louis, Missouri 63125