Thank you for offering to help!  Please print out this page, fill it out, and then send it to me at:

Brozosky For Mayor
P.O. Box 5521
Pleasanton, CA  94566

Steve, I want to help you with your campaign! Please check as many spaces as apply:

___ You may use my name publicly in an endorsement:

 ___________________________________          ___________________________________
Your Signature                                                          Spouse's Signature

___ Sign in yard.                                                                  ___ Host a neighborhood meeting.
___ Drop off campaign flyers in my neighborhood                 ___ Write a letter to the Editor.
___ Send endorsement letter to friends and/or                       ___ Donate services or materials:
       associates (samples available)                                               ______________________
___ Help with campaign

___ Enclosed is my Contribution for: ___$20  ___$50  ___$100 ___ $250 ___ $500 ___ $_________

 Please make check payable to: BROZOSKY FOR MAYOR
                                                P.O. Box 5521, Pleasanton CA 94566.

Name _________________________________________________________________________

Address _________________________________ City _____________________ Zip _________

Phone: __________________________________ Email: ________________________________

If making a contribution, information below required:

Occupation/Employer_____________________________________________________________