B U M P E R S T I C K E R R E Q U E S T F O R M (Please allow several weeks for delivery)

Which bumper sticker do you want?

Title

Other Title

First Name

Middle Name / Initial

Last Name

Name Suffix (Jr. / M.D. / religious orders / etc.)

E-mail

E-mail (validation)

Address 1 - Street

Address 2 - Unit / Suite, etc.

City/town

State

Zip code

Phone Number

Format: ###-###-####

Diocese / Archdiocese / Eparchy

Parish Name

Parish City / Town

	Female	Male
Gender

Age

OTHER CONCERNS

	Yes	Maybe	Not at this time
Would you like to volunteer?

OTHER INTERESTS & SKILLS

Please include any other comments or thoughts you may here

Budget / Economy / Jobs	Dignity of Life
Education	Environment
Fairness in a Progressive Tax Code	Health Care
Immigration	Poverty / Children / Families / Elderly
Rights of Labor	War & Peace / Foreign Policy

Administrative	Arts - Design / Fine Arts / Graphic Arts
Arts - Music	Catholic Social Justice Tradition / Theology
Communications / Media	Database - Excel / Relational
Development / Fund Raising	Editing / Writing
Marketing / Advertising	Organizing / Voter Registration / De-politicizing Parishes
Political Research / Analysis	Public Policy Research / Analysis
Spiritual - Prayer & Vigils	Technology / Web Site