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Thank You for Your Interest in the

Libertarian Party of Indiana


For more information on the LPIN, Please fill out the information below.
www.lpin.org www.lp.org

Name: f?4i' hlZ-ft, e // Phone Number: 51'-/·2-7 g - /y 7 L(


Address: :23~"7 (!O"'l .,<--'c/ ( OJt)v/)A.- City/State: S. ~GAJL) Zip: .~~2. g'
County: ,::7....:;;'65-=...,:>),
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Occupation: Scvz A ) { (, L<S';jvcS'<

Email: ~2ye.e.e I Ifiii.vc.S"s@G/l1litl.ReceiveEmails?(YIN)_--I-)l _


I Coi'l.'!

Name: J2.ArQ.G1 VVCiles Phone Number: _


Address: City/State: _______ Zip:

County: _________ Occupation: . _


Email: Receive Emails? (YIN) _

Name: (dO.f\..l ~ .A\A~("-or 0IA.~ clLb D4-t'\er Phone Number: ~~ ~ ~~ 1- gg ~ ~


Address: t 0 A d--L~~Y\u:t &- City/State: l ,e..O :ctJ Zip: L/&z11oS
County:. R \ l-e..n Occupation: Co..c p e.~ -uc lito Y"Y\.~I4r::
Email: \A-Q'D e Cf'\ f)ChO-Ao.. . Dr j Receive Emails? (YIN) A 11~D..~ d1)

Name: ~ 14/<.. t<c:> S.SCA... Phone Number: _


Address: City/State: Zip:
County: _________ Occupation: _
Email: Receive Emails? (YIN) _

Name: ALL (SOlv Phone Number: _

Address: ______________ City/State: Zip:


County: _________ Occupation: _
Email: ______________ Receive Emails? (YIN) _

--.-. IN) r7 C;
Name: ::lll11-VVl~r=t::.'____"_ALl...>U""----.Ll-'---'L-------'C-=------- Phone Number: _
Address: City/State: Zip: _
County: Occupation: _
Email: Receive Emails? (YIN) _

Office Use Only:

Event: Attendance: Date: _

Organization or County: Funds Raised: New Members: _

Paidfor by the LibertarianPartyof Indiana


LPIN, 156 E. MarketStreet, Suite405, Indianapolis,IN 46204, (317) 920-1994, 1-800-388-1776
Thank You for Your Interest in the

@,:'
~
Libertarian Party of Indiana
For more information

www.lpin.or"
on the LPIN, Please fill out the information

www.lp.org
below.

Name: --.J2f.<.X)(\ ~') () ~M ',\\)f \. Phone Number: 317 - ;.), 3- <5'ill/


Address: 5']}1 w ~t )-\-e.. D r ~" City/State: _J-_W"------""-- Zip: ~b J- )"Y
County: (V) o...r I 0.1\ Occupation: _
Email: ~ C(.\C\(\ \ <, -- b~~~\)! ~ t I~\~-t:.'''''keceive Emails? (Y IN) _

Name: M~+r W,:--l+\IJ Phone Number: _


Address: )~ City/State: ------- Zip: -----
County: Occupation: -,- _
Email: Receive Emails? (Y IN) --'1-7'-' _. _
Name: .~) \A- ~-¥JLST()t5i. Phone Number: (\~i)~
~D-bL{;d6
Address: Cl\6 ];~<)·-rl'" ~8-""" City/State: ~~(,~c)L...( ') Zip: ~~;)t1
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County:
Email: ?<C- \OG/---@5'':I'-:<\'C
~l<,)~ Occupation:
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Name: (;-~ 40:-- /f/t! '-If 1//) Phone Number: _


Address: ______________ City/State: Zip: _
County: Occupation: _
Email: Receive Emails? (Y/N) _

Name:~13 :7 CJ '7 UI/ ~( Phone Number:


----------
Address: ______________ City/State: Zip: _
County: Occupation: _

Email: ""7-----,-----=ot----,------ Receive Emails? (Y IN) _

Name: r.&{~/ IZJ Phone Number: _(P~~,-7-,------,-f)L-q-<...>.<:d--=S""=----- __


Address: jJ~tj &. (me-a J A"tf.
County: Occupation: --.l.-4Ut":ofdi.!.L::\f-'--l~+-~~-.!....:..J.t:.~:!..r-----

Email: f;<iA L 41fj) C8111ea~"0uer


Office Use Only:

Event: . Attendance: Date:

Organization or County: Funds Raised: New Members: _

Paid for by the Libertarian Party of Indiana


LPIN, J 56 E. Market Street, Suite 405, Indianapolis, IN 46204, (317) 920·1994, 1·800·388·1776
Rc\"i~I·20.09CMS
Phone Number:
--------------------
Address: City/State: Zip: _
County: Occupation: _
Email: Receive Emails? (YIN)

Name: ~ \krl') +- Phone Numb,-r: 7-;-Cj ~-J-t-r---


Address: ~) :2;J -::) ~L IV f?w\t:::= City/State: ~o----r Zip: Y lR ~ ? L.
County: Y\rv - Occupation: r-------------~c-------------------
Email: '\O! \ UUC\. (\1",---> t @V (J rnfJ; ( Receive Emails? ~) _

Name: 0 VL~ ~c.....(' Phone Number: J \(- -;:2 8 ~ (J ~~ .J


Address: b~ 'S 0 L-i ~ Q I City/State: DJ<'-",-",,,,,(~\:~p: l..( <- 2'1...'\
County: (V\.e.-r l' <> A Occupation: S ~J'-."..A.~
------------~------------------------
Email: J ~J ~ tI'-'- '\ 5e~G.-.k ••'l. ~-••.,.. Receive Emails?~) _

Name: PhoneNumber: _
Address: City/State: Zip: _
County: Occupation: _
Email: Receive Emails? (YIN) _

Name: PhoneNumber: _

Address: City/State: Zip: _


County: Occupation: _
Email: Receive Emails? (YIN) _

Name: PhoneNumber: _
Address: City/State: Zip: _
County: Occupation: _
Email: Receive Emails? (YIN) _

OfficeUse Only:

Event: Attendance: Date: _

Organizationor County: Funds Raised: New Members: _

Paid for by the Libertarian Party of Indiana


LPIN, 156 E. Market Street, Suite 405, Indianapolis, IN 46204, (317) 920-1994, 1-800-388-1776
Thank You for Your Interest in the
I
I' '
. .
•.
. 1 Libertarian Party of Indiana
:'P.4R~ ,
For more information on the LPIN, Please fill out the information below .
.• ro,

~ www.lpin.org www.lp.org

Name: f' U I\J ( ~ N K v' 5 fi Phone Number:f 7 ~ ;, 7 ~ 3 ~ ~ Lr


Address: S- S' I (/ \J OA~ j A...
(C ...• City/State: (}5 C~ d l./'j- .:z:-tfp: ipuJ-(J (
County:.\ S- . -,) \, r~
\:: Occupation: _
Email: ~ c.~ tvv-vj/1 eAi"\1" A'I\... ,<:".J {V\ Receive Emails? (YIN) _-/- ',I _

Name:@6' lkkr~ If Phone Number: _


Address: City/State: Zip: _
County: Occupation: _
Email: Receive Emails? (YIN) _

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Name: __ oo--"ce.........,~~
-->,r"--"~'_1·10=--=------,',----,//'---'-'. Phone Number: 3 /7- 6 <Y ..5- - 76..3.:2....
Address: City/State: Zip: _
County: Occupation: _
Email: roJ,-cr+ek,<e7b(i2 Wle. (-0f4'1 ReceiveEmails@N) _

Name: -:s-\ M. ~ C A ,-1;;)L Phone Number: _


Address: City/State: Zip: _
County: Occupation: _
Email: '\M.tSl,,,,,,,)a.)-if G} vtZ\"'co· (O''\.-~ Receive Emails? (YIN) _
•• I

Name: Jf rt.EiU IA {{ HOfZfLf:..LC Phone Number:


Address: City/State: Zip:
County: Occupation:
Email: Receive Emails? (Y/N)

Name: Pl~·l ,fYL lt~ Phone Number:


Address: City/State: Zip:
County: Occupation:
Email: Receive Emails? (YIN)

Office Use Only:

Event: Attendance: Date: _

Organizationor County: Funds Raised: New Members: _

Paid for by the Libertarian Party of Indiana


LPfN, 156 E. Market Street, Suite 405, Indianapolis, IN 46204, (317) 920-1994, 1-800-388-1776
Rc\'i",dS-20-WCI>IS
Thank You for Your Interest in the

Libertarian Party of Indiana


For more information on the LPIN, Please fill out the information below.
~ www.lpin.org www.lp.org

Name: ~~ ~ ~ ~ Phone Number: rJ2-?/11-U~3Lf, g";Z-51"1-r;r15


Address: 33304JJLOCU City/State: .Adttfh'nS\l1·tltz(t! 4Ct/5/ I
County: vM-cqyJ.YI Occupation: S (jI\W[IvJ~ S / S Al±.L.:...tI\~ _
Email: Receive Emails? (Y~) _

Name: ~ Y-VJ I ~ ·tvs. Phone Number: _

Address: ~ t
-------f,-----------
I
City/State: Zip: _
County: Occupation: _
Email: Receive Emails? (Y/N) _

Name: PhoneNumber: _
Address: City/State: Zip: _
County: Occupation: _
Email: Receive Emails? (Y/N) _

Name: PhoneNumber: _
Address: City/State: Zip: _
County: Occupation: _
Email: Receive Emails? (Y/N) _

Name: PhoneNumber: _

Address: City/State: Zip: _


County: Occupation: _
Email: Receive Emails? (Y/N) _

Name: PhoneNumber: _
Address: City/State: Zip: _
County: Occupation: _
Email: Receive Emails? (Y/N) _

Office Use Only:

Event: Attendance: Date: _

Organization or County: Funds Raised: New Members: _

Paid for by the Libertarian Party of Indiana


LPIN, 156 E. Market Street, Suite 405, Indianapolis,IN 46204, (317) 920-1994,1-800-388-1776
Rcviscd8-Z0-C9CMS

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