Contributor Information:

First Name:
Last Name:
Title:
Company:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
Corporate Options		Individual Options
Platinum Sponsor:	$5,000 or $425/month	Platinum Sponsor:	$1,000 or $85/month
Gold Sponsor:	$2,500 or $225/month	Gold Sponsor:	$750 or $65/month
Silver Sponsor:	$1,000 or $100/month	Silver Sponsor:	$600 or $50/month
Bronze Sponsor:	$500 or $50/month	Bronze Sponsor:	$300or $25/month
Friend: (Enter amount below)	Contribution or Monthly	Friend: (Enter amount below)	Contribution or Monthly
Amount of Friend Contribution or Monthly Payment:$ (numbers only)
I am willing to attend events located in my district. Yes    No
How would you like to make your contribution: Credit Card Mail Contribution

 

By law PAC contributions are not deductible as a business expense.