Name: First: Last:    Address: Street: Apartment: City: State: Zip:    Contact Information: Home Phone: Pager: Work Phone: Fax: Cell Phone: E-mail:    I would like to help Richard by: (check all that apply) Placing yard or window signs Helping on Election Day Accompanying Richard to public events Hosting a Fund Raiser Hosting a meet-the-candidate Making Telephone Calls Distributing Campaign Literature Sending letters to friends, family and neighbors Going door-to-door Holding a sign on a street-corner Putting a bumper sticker on my car Other:

Political advertisement paid for and approved by Richard L. Steinberg, Democrat, for State Representative.
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