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Business/Location Name
Your answer
Business/Location Address
Your answer
Petition signing hours
Your answer
Business/Location phone number
Your answer
Your personal phone number, so we can contact you directly for setup/pickup (will not be published online)
Your answer
Your personal email, so we can contact you directly for setup/pickup (will not be published online)
Your answer
Are you the business/location owner, manager, or have authority to authorize the signing of petitions at this location?
Yes
No
Clear selection
Do you have petitions already?
Yes, I have plenty.
Yes, but I need more.
No
Clear selection
Are you willing to collect signatures, or are you requesting to have a volunteer present?
I'll collect signatures
I need a volunteer (staffing may be limited)
Clear selection
Submit
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