WE INVITE YOU TO GET INVOLVED WITH DR. KIM'S CAMPAIGN

Thank you for your willingness to contribute to Dr. Kim's campaign. We appreciate your support and your interest in making Spokane County a better place for everyone.

Please take a few minutes to complete the following form.
Note that an asterisk (*) indicates a required field.

1. YOUR NAME   FIRST: LAST: * *

2. E-MAIL ADDRESS   E-MAIL:

3. PHONE NUMBERS   PRIMARY: SECONDARY: (optional) - - * - -

4. MAILING ADDRESS   ADDRESS:   * CITY: STATE: * WA AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AS FM GU MH MP PR PW VI AA AE AP AB BC MB NB NF NS NT NU ON PE QC SK YT * ZIP:   *   * Address required to receive literature by postal mail.

5. HOW DID YOU LEARN OF DR. KIM?   Advertisement Sign or Poster From an Event From a Friend Internet Search Other: Public Health Officer

6. HOW WOULD YOU LIKE TO CONTRIBUTE?   Doorbelling Host a house party Help with mailings Sign-waving Distribute literature Phone-calling Help with data-entry and clerical Place a campaign sign on my property Attend and/or help at events Help with placing campaign signs Suggest an event for Dr. Kim to attend: Introduce Dr. Kim to my organization: Other:

7. PERSONALLY ENDORSE DR. KIM   Are you willing to personally endorse Dr. Kim? Yes, it is okay to include my name in a publicized endorsement.

8. SUBMIT   By clicking the Submit button, you certify that you are the above-named person and that the information contained above is true and correct. Dr. Kim and her team sincerely appreciate your support.