Campaign & Political Marketing Solutions

First Name

Last Name

Telephone

Address

Apt./Unit./Suite

City

State

Zip

Date of Birth

Social Sec. No.

Position

Canvasser

Phone Banking

Election Day (12-Hour Day)

Other

Availability

Day's

Sun

Mon

Tue

Wed

Thurs

Fri

All

Time

Morning

Afternoons

Evening

All Time

Question	Yes	No
Are you 18 or older?
Do you have a valid driver’s license?
Are you willing to travel?

Acknowledgment: If you earn more than 600.00 on one year we issue a 1099 Tax Form.