Your Full Name:__________________________________
Address:_________________________________, City:_______________, State:___ Zip:_______
Employer:______________________________________ Occupation: _____________________
Your Phone (optional):_____________ Your E-Mail address
(optional):_____________________
Amount enclosed : $__________check payable to "Friends of Scott Petri"
Mail to: Friends of Scott Petri, P.O. Box 161, Richboro, PA 18954
I would also like to become involved with the Campaign or volunteer to help as shown
below:
__Fundraising __Registrations__Poll Worker__Sign on lawn__Make phone
calls__Other___________
N.B. Political contributions are not tax deductible as a charitable contribution for
income tax purposes. Also, corporate checks are prohibited by law.