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FRIENDs of Dana Agreement
2002 Election

YES, I would like to support Dana Dickens                               Enclosed is my contribution of:
for Suffolk City Council.

                                                                                                ____$1,000  ____$500  ____$250  ____$100  ____$50  ____other $____                                                                                                

You can count on me to:                                                     Name:________________________________________________________

__ Host an event for Dana in my home                      Address: ______________________________________________________

__ Put a bumper sticker on my car                                                                   

__ Display a yard sign                                                        City: ___________________________State: ________  Zip: ____________

__ Volunteer in the campaign office

__ Distribute information to my neighbors                              Phone: __________________________ Fax: _________________________

__ Contribute financially                                                             

E-mail address: ________________________________________________

Employer: ________________________ Occupation: __________________

Political contributions are not tax deductible as charitable contributions for the purpose of federal income tax.  Corporate contributions can be accepted.  State law requires political committees to report the name, mailing address, occupation and name of employers for each individual whose contributions aggregate in excess of $200 in a calendar year.  Paid for and authorized by E. Dana Dickens for City Council.

Mail to:

Dana for Councilman
P.O. BOX 6150
Suffolk, VA 23433

Thank you !! 

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