Volunteer and Contribution Form

Maryland Committee to Elect Austin
Kathleen M. Otto, Treasurer
P.O. Box 121
Brookeville, MD 20833-9900
(301)774-3057

www.electaustin.org
kateotto@electaustin.org

Volunteer and Contribution form

Name:

______________________________________

Phones:

(work)

_____________________________

______________________________________

(home)

_____________________________

Address:

______________________________________

(cell)

_____________________________

______________________________________

e-mail address:

_____________________________

I would like to help the campaign by assisting in the following (check all that apply):
	contribute my time (phone bank, walking the precincts, distributing flyers, etc)
	contribute my money
	contribute my name as an endorsement
	raise funds
	post a sign on my property and/or business
	do opposition research
	do voter registration
	host an event (coffee, breakfast, lunch, dinner, club meeting, fund raiser)
	help out some other way

Employer and occupation (required for financial contributors):

______________________________________________________________________________________

You can make an immediate donation electronically by using PayPal (below) or to donate by mail:

Please make your checks payable to: Maryland Committee to Elect Austin

Please enclose this form and return it to:

P.O. Box 121
Brookeville, MD 20833-9900

Suggested campaign contribution levels are:

Golden Eagle $4,000.00
Inner Circle $1,000 +
Platinum $750.00
Gold $500.00
Silver $250.00
Bronze $100.00
Founder $50.00
Supporter $25.00

Thank you.