YES, I want to help CONCERNED CITIZENS FOR SANTA ROSA!

Enclosed is my contribution:

__ $500 __ $250  __ $100  __ $50  __ $25  __ Other  $_______      __ $35 CCSR Membership

I will attend the event on June 12th.  Enclosed is my contribution of: ___________

ٱ Please list me as a sponsor for the event.

ٱ I am unable to attend.  Enclosed is my contribution of: ______

I understand that CONCERNED CITIZENS FOR SANTA ROSA is a volunteer organization.

Here’s how I can help:

__ Walk a neighborhood   __ Display a yard sign

__ Make phone calls   __ Deliver / put up signs

__ Host an event at my home    __ Send pre-printed post cards friends

__ Do office work   __ Donate a silent auction item

__ Other:_________________________________________________________________

Please fill out information below to help us comply with state law.

Print Name(s) ____________________________________________________________

________________________________________________________________________

Address__________________________________________________________________

Home Phone __________________________ Work Phone_________________________

*Occupation __________________________ *Employer __________________________

E-mail address _________________________

*Required by law if making monetary contribution.

Please make checks payable to: CONCERNED CITIZENS FOR SANTA ROSA

Contributions to this organization are not tax deductible.

Please mail to:

CONCERNED CITIZENS FOR SANTA ROSA

1275 Fourth Street, #386

Santa Rosa, CA 95404

Thank you for your support!