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Please print & fill out, then fax to submit.
FAX: (877) 260-0657 Attn: Metropolitan Democratic Club Treasurer
YES,
I want to support: MDC /
MDC Scholarship Fund.
[ ]
Please bill my: In the amount of
$_______________
[ ]
Visa [ ]
American Express Card
#__________________________Expires____________
[ ]
Master Card [ ] Discover Signature__________________________________________
Name,
as it appears on credit card.
[ ] If
this is an RSVP for an event, please indicate the date of the event:
______________________________
[ ] I
also want to give my support in the following way(s):
[ ]
Hosting a Coffee or Fundraiser [ ] Staffing Campaign Office [ ]
Phonebanking
[ ]
Walking Precincts [ ] Displaying a Yard Sign [ ] Other, Please Call Me
[ ]
You may use my name as a supporter:
______________________________________________________
(Signature)
For more information please
call (_____)_____-_____.
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To enable us to comply with campaign laws,
please PRINT the following:
Name __________________________________________________________________________________
Mailing Address
_______________________________________ Apt/Suite
#________________________
City_________________________________________
State __________ Zip ________________________
Phone
-Day (_____) ______________________ -Evening
(_____) __________________________
Fax (_____) ______________________ Email
___________________________________________
Employer
_______________________________ Occupation______________________________________
Name of business if self-employed
____________________________________________________________
Please complete
the above form with full information.
Thank you!
Paid for by: Metropolitan
Democratic Club. A registered State and Federal Committee
State I.D. # 1279396
Federal I.D. # C00415513
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