Endorsement Form

☐ YES! Mark for Portland 2020 can publicly use my name as an endorser!
Please list my name as _________________________________________________________________________

Please check the list that best describes your support. Portlanders who own a business, lead a nonprofit organization, or are a member of a City of Portland Neighborhood Association, Committee, or Commission, can be on two lists if they wish. An asterisk (*) will be used to disclose you are on more than one list.

☐ Portland resident ☐ Please include my neighborhood name ___________________________________________________________________________________________________

☐ Oregon resident, outside of Portland ☐ Please include my town or city ___________________________________________________________________________________________________

☐ Not an Oregon resident
☐ Please include my town or city, state, and/or title ___________________________________________________________________________________________________

☐ Portland company/business, nonprofit, or Portland community-based organization
☐ Please list as ___________________________________________________________________________________

☐ Oregon Mayor
☐ Please list my town or city _____________________________________________________________________

☐ Other Oregon elected official
☐ Please list my town or city and/or title as ______________________________________________________

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If you are under the age of 18 and would like voters to know you want to participate in the Portland Youth Corps, you can let them know by joining a separate list just for youth support of the Portland Youth Corps. You must have permission from your parent/s or guardian/s for your name and/or age to be posted publicly. A signature line for a parent or guardian is at the end of this section. If you do not have permission for your name and/or age to be publicly posted, you will still be counted in the total number of youth supporters. If you have permission from your parents, please print your name at the top of the page how you would like it to appear.

☐  I am under the age of 18 and want to support the creation of the Portland Youth Corps.

☐  I am ______ years old.

☐ I live in Portland ☐ I do not live in Portland. I live in ___________________________________________

If you want to let people know why you like the idea of the Portland Youth Corps or why you want to participate in it, you can do that here.

___________________________________________________________________________________________________Parent or Guardian signature/date

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☐ YES! Please add me to your e-mail list! My e-mail is ___________________________________________________________________________________________________

☐ YES! I want a lawn sign or signs! I need _____ sign/s. (please specify amount)


_____ Please deliver sign/s to my address: _____________________________________________________

_____ I will pick up sign/s. Please call me at __________________________________ when available.

☐ YES! I am interested in hosting a house party! Please contact me to set up a date and time.

Please provide preferred method of contact __________________________________________________

This document created by Mark White and paid for by the Mark for Portland 2020 campaign. MarkForPortland2020@centurylink.net — 503-761-0222

v.02.05JAN20