First Name: Last
Name: Occupation:
*state
law requires this information Employer: *state
law requires this information Phone: Email:
Address
1: Address
2: City:
State:
I
would like to contribute: $25
$50
$100
$200
$400
Other
amount Please
send me more information: I
would proudly place a sign in my front yard I
live in Senate District 13
Scott
Renfroe for Senate PO Box 337512 - Greeley, Colorado
80633 970-539-0774 - www.scottrenfroe.com
Paid
for by Scott Renfroe for Senate, Rob Price Treasurer