Yes, I want to help Kevin Shelley reform the voting process and bring disenfranchised Californians back to the polls.

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first name		last name
address (line 1)
address (line 2)
,
city			state	zip
( )		( )
areacode	home phone	areacode	work phone
		( )
email (e.g., you@yourISP.com)		areacode	fax number
Check as many as apply.
	Use my name as a supporter
	I'll be a Shelley Campaign eCaptain
	I'll display window sign or yard sign
	I'll display a bumpersticker
	I'll host a fundraiser
	I'll pledge a contribution of...		$
Please print out a remittance form and return it to 5214-F Diamond Heights Blvd., #733, San Francisco, CA 94133-2118 along with your contribution.