I want to help Jack by (please complete this form):

Placing a sign in my yard

Placing a sign at my business

Helping with mailings to voters

Making a contribution (payable to The Committee to Elect Jack Arrowsmith)

Amount Enclosed: $25 $50 $100 $200

Jack can use my [our] names as a supporter:

Signature ________________________________________________ Date ________

Print this form using the button below. Enclose your check payable to The Committee to Elect Jack Arrowsmith: