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I would like to help by... ___ Placing a Sign in my Yard ___ Flyer Distribution ___ Phone Calling ___ Helping with Events or other Promotion ___ Include my name on the NO on 3-164 supporters list 1) Print this form. 2) Check 1 or more of the above. 3) Sign the form and mail to. Oak Lodge Citizens Against 3-164 PO BOX 68085 Oak Grove, OR 97268 I indicate, by signing this "NO on 3-164 Signature Form", that I am against the Regionalization of Wastewater Treatment at a Single Facility as proposed in Ballot Measure 3-164 I also indicate that my name can be included as one of the Oak Lodge Citizens Against 3-164 on flyers, advertisements, a website or other communication methods used to get this message out. Signature:________________________________________ Print Name:_______________________________________ Optional Contact Information: Address:_____________________________________________________ Home Phone #:_________________ Work Phone #:_________________ Cell Phone #: __________________ FAX #: ______________________ E Mail Address:_______________________________ |
