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Law requires we ask for your employer and occupation. If you don't have an employer or are retired, put N/A, and if you are self-employed put "self-employed" in employer and describe your occupation.

Contributions are not tax deductible.

$5  $25  $50  $100  $250  $1,000  $2,500   Other $

I AFFIRM THAT THE FOLLOWING STATEMENTS ARE TRUE AND ACCURATE: 1. This contribution is made from my own funds, and not those of another. 2. I am not a foreign national who lacks permanent resident status in the United States. 3. I am at least 18 years of age.

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