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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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