First Name:
Last Name:
Employer:
e-mail:
Phone:
Address:
City:		State:		Zip:
	I will be there with   guest(s)  Unfortunately, I can not attend, but I am happy to make a contribution.

Paid for by the Sikora for Justice Committee, Christopher Green, Treasurer, 2549 Forest Parkway, Westlake, Ohio 44145 info@sikoraforjustice.com.com