Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

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YES! I would like to help the Rensselaer County Democratic Committee by: (check all that apply)

Running for office as a Democratic candidate

Making a financial contribution

Volunteering with literature distribution or walking with candidates

Allowing a candidate's yard sign on my property

Assisting with phone banks near election time

Circulating petitions in your neighborhood

Other (indicate below)