I need 5 things:
1. family name, initials, example: SelinKAJ
2. date of birth, year-month-day: 53-04-25
3. $10
4. your e-mail address for the election of the É(eh)PC candidate in the riding
5. I need you to say: "I refuse to be a crook!"

1. ............................. 2. ............................. 3. ............................. 4. ............................. 5. I refuse to be a crook!	1. ............................. 2. ............................. 3. ............................. 4. ............................. 5. I refuse to be a crook!	1. ............................. 2. ............................. 3. ............................. 4. ............................. 5. I refuse to be a crook!
1. ............................. 2. ............................. 3. ............................. 4. ............................. 5. I refuse to be a crook!	1. ............................. 2. ............................. 3. ............................. 4. ............................. 5. I refuse to be a crook!	1. ............................. 2. ............................. 3. ............................. 4. ............................. 5. I refuse to be a crook!
1. ............................. 2. ............................. 3. ............................. 4. ............................. 5. I refuse to be a crook!	1. ............................. 2. ............................. 3. ............................. 4. ............................. 5. I refuse to be a crook!	1. ............................. 2. ............................. 3. ............................. 4. ............................. 5. I refuse to be a crook!
1. ............................. 2. ............................. 3. ............................. 4. ............................. 5. I refuse to be a crook!	1. ............................. 2. ............................. 3. ............................. 4. ............................. 5. I refuse to be a crook!	1. ............................. 2. ............................. 3. ............................. 4. ............................. 5. I refuse to be a crook!