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Last Name:
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State and Federal laws require us to ask Occupation and Company Name. It is your option to respond with, "Decline to state".
Contribution Amount
Other: $
$10
$50
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$
500
Compliance
By checking this box, I certify that:
(1)
This contribution is made from my own funds and will not be reimbursed by any other person or entity;
(2)
This contribution is not made from the treasury funds of a corporation, labor union, or national bank;
(3)
I am a U.S. citizen or lawfully admitted permanent U.S. resident; and
(4)
I am not personally a federal-government contractor (employees of government contractors may contribute).
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