| Full Name: |
|
| Last
Name: |
|
| Home Address: |
|
| City: |
|
| Zip
Code: |
(5 digits) |
| State: |
|
| Home Phone: |
|
| Cell Phone: |
|
| Email: |
|
| I can assist in the following way(s). Check all that apply |
I will host a reception, or "Coffee for Max" |
| |
I will host or help with another fundraising event |
| |
I will arrange for Max to speak at an event |
| |
I will help with phone calls |
| |
I will donate professional services (legal, advertising, publishing, video, etc) |
| |
I will wave signs |
| |
I will help with mailings |
| |
I will offer business resources (phones, meeting places, equipment, etc.) |
| |
I will put up signs at home or business |
| |
Other - please specify below in comments |
|
|
