Name *

First Name

Last Name

Address

The individual house address is not necessary if it's easier you can say things like, "Fairfax Street between Foothill and High Street." We use heatmaps so we can share an area vs. individual housing units.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Will you be able to do more flyering? *

Yes

No

Maybe

Did you print your own flyers or pick up a stack at a Melrose location? *

We post maps so you can use them and contribute your own flyers to the cause. You can also pick up a stack at designated flyer locations.

Printed my own

Picked some up

Both