Yes! I Support Brian L. Gotlieb!

Please complete the form below and give your endorsement to Brian L. Gotlieb.
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By my Digital Signature, I give Brian L. Gotlieb and Gotlieb2009 permission to use my name on literature and advertisements indicating that I have endorsed his candidacy.
Digital Signature (Re-enter your name as it appears above)
Today's Date:	May 21st, 2012