First Name*:

Last Name*:

Email*:

Address:

City:

State: Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip:

Home Phone:

Business Phone:  Please Don't Call Me Here

Occupation*:
Self-employed, business owner, sales are not acceptable as occupations.
Retired and unemployed are acceptable as occupations.

Employer*:
If you are self-employed you may list self-employed as your employer unless you are employed by a corporation.

Employer City*:

Employer State*: Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

I would also like to help in the following ways:

(check more than one if applicable)

 Hold a neighborhood coffee

 Put up a lawn sign

 Walk neighborhoods with Matt

 Help with mailings

 Provide computer help

Please type the letters/numbers below (anti-spam protection)*:

Thank you for your support.

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Paid for and authorized by FRIENDS OF MATT WINGARD.
Your contribution may be eligible for the Oregon Political Contribution tax credit. Contribution to the Friends of Matt Wingard are not deductible as federal or Oregon charitible or business deductions. If you have questions you should consult your tax advisor.