Please Print this Page Out and Fill it out,

I will: DONATE: $ 25 $50 $100 $200 $325



Enclose $ _____________

• I’ll display a State Representative yard or widow signs.

• I’ll deliver campaign literature.

• I’ll make phone calls.

• I’ll address envelopes.

• I’ll help at the polls on Election Day.

• Purchase a Bumper Sticker for $3.00

Missouri Ethic law requires the following information: ($325.00 max per person, per primary & general for a total $650.00 recorded)

(Please Print)

Name____________________________________________________________________

Address__________________________________________________________________

City/State/zip______________________________________________________________

Phone (H) __________________ (W) ___________________ (C) ___________________

Fax ___________________________ E-Mail ____________________________________

Occupation ________________________Employer _______________________________

Excess of $500 with the State of Missouri. ___ YES ___ NO

If yes, briefly describe _______________________________________________________

____ please contact me. I would like to help Mr. Gambino with his campaign.

Please make check payable to: Citizens for Joseph Gambino

% Dwyer Costello Knox CPA

Terrance Knox CPA Treasurer

#8 Pines Court, Suite A. St. Louis, MO. 63141

Paid for by Citizens for Joseph Gambino – Terrance Knox CPA Treasurer