Endorsement Form

Yes! I/we want to be part of the Kids Are Priority One coalition!

After you have filled in the information below, print this page and mail or fax it to:

Kim Friedman
Windham Child Care Association
130 Birge Street
Brattleboro, VT 05301
Fax (802) 251-7200

Type of Endorsement
(check one) 		Individual     Organization
Individual/Organization
Organization Contact
(if applicable)
Street
City/Town   Zip
Legislative District
(if known)

House
Senate
Phone Number
Best time to reach you: day    night
Fax
Email



____________________________________________________________
SignedDate