Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

I'd like to join Team Chistina! I can help by:

(check all that apply)

Hosting a fundraiser

Walking my neighborhood

Placing a sign in my yard or business

Working on Election Day

Identifying speaking opportunities

Hosting a “Meet and Greet” in my home

Using my name as an endorsement