Name _____________________________________________________

Address___________________________________________________

Phone_______________________ Email_________________________

Hours of Work_______________ RDOs__________________________

Division/Title______________ Work Location_________________

____ I would like to help defeat the James Gang. Call me.

____ I will distribute New Directions campaign material where I work.

____ Here is a contribution to help meet campaign expenses. (Please make checks payable to "Hell on Wheels".)

____ Good Luck!

Please send completed forms to New Directions, P.O. Box 1346, Bronx, NY 10471

You can print this form out and mail it in.

2