First Name        
Last Name        
Mailing Address  
Apartment        
City             
State             
Zip Code         
Daytime Phone    
Evening Phone              
Fax?                             
E-Mail?          
Organizations?   
Spoken languages             
Written Languages

I am willing to (check all that apply):

	Gather signatures for the initiative
	Help organize other volunteers
	Help spread information by phone, fax, or e-mail
	Help translate materials for the campaign
	Help raise funds for the campaign
	Help the campaign in other ways as necessary