How you can Help Ted

Ted Laliotis – State Assembly
21st Assembly District

HOW YOU CAN HELP!

Ted is running a strong campaign on the important issues. But he needs your help in ensuring that his message gets out.

If you would like to support Ted or join the Laliotis for Assembly campaign team, please fill out the following form. For better security, we recommend you print the form out and fax or mail the completed form via the contact information below. Thank you for your support!

FAX/MAIL-IN FORM

I would like to help Ted by:

[ ] Putting a yard sign in my Lawn
[ ] Making phone calls to get out the vote
[ ] Doing a precinct walk in my neighborhood
[ ] Hosting a get-together with neighbors
[ ] Contributing to the Campaign

Please indicate the amount of contribution:

							   
[ ] $250  [ ] $200 [ ] $150  [ ] $100 [ ]  $50

Contributor Information

       Name: [                                                  ]

    Address: [                                                  ]

       City: [                                 ] [CA] [             ]

      Email: [                                                  ]

  Day Phone: [                          ] Fax: [                         ]

 Nite Phone: [                          ]

[ ] Please Add My Name to Ted's List of Supporters

    Name: [                                                              ]

   Title: [                                                              ]

 Company: [                                                              ]

Make Contributions Payable to:
“Laliotis for Assembly Committee”

(Remember state law requires you include your Occupation and Employer)
FPPC ID# 950688

Please print and fax or mail this completed form:

Laliotis for Assembly 61 Doud Drive Los Altos, CA 94022 Phone: 415.941.1752 Fax: 415.941.6721

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E-mail: ted@laliotis.org
61 Doud Drive, Los Altos, California 94022
Phone 415.941.1752 * Fax 415.941.6721