I would like to contribute:
$30.00
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$75.00
$100.00
$150.00
$250.00
$500.00
Other: $
Your Name:
Last Name:
Email Address:
Campaign finance law requires us to collect and report your occupation and employer.
Occupation:
Employer:
If not employed, please enter "none". If self-employed, please enter "self". If not employed, please enter "none".
Contribution Eligibility
I confirm that the following statements are true and accurate.
1. This contribution is made from my own funds, and not those of another.
2. My contribution is not from general treasury funds of a corporation, labor organization, or national bank.
3. I am not a federal government contractor.
4. If a foreign national, I have permanent resident status and hold a green card.
5. If a minor, I am voluntarily making this contribution, which consists of my own funds; my contribution is not controlled by
another individual and is not made from a gift given to me to make this contribution.
6. I am making this contribution with my personal credit or debit card for which I have a legal obligation to pay, and not
through a corporate or business entity card or the card of another.
