Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Pledge for Campaign Yard Signs, T-Shirts, and Masks for Raquetta Dotley for City Council District 7
Sign in to Google
to save your progress.
Learn more
* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Would you like to pledge $30 to receive a campaign T-Shirt?
Yes
No
Clear selection
Would you like to pledge $10 to receive a campaign yard sign?
Yes
No
Clear selection
Would you like to pledge $15 to receive a campaign protective mask?
Yes
No
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Campaign to Elect Raquetta.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report