Contact Information:
* Required Field
|
| *
Full Name: |
|
| *
Address: |
|
| *
City: |
|
| *State/Prov |
|
| *Zip Code/Postal Code: |
|
| Country |
|
| Phone: |
|
| Email: |
|
| Employer: |
|
For recognition, please list
Donor name(s) here: |
|
Select a Donation Amount
Your donation to the Community Fund
will enable local volunteers to invest your contribution based on community
needs. This is the best way for your donation to have a significant impact.
|
|
Select a donation amount: |
Recurring Monthly |
Other Amount:
($5 minimum) |
Recurring Monthly
|
|
Designate a Focus Area (optional)
You may designate your gift to a specific Focus Area (limit one).
|
|
Congressional District: |
|
|
Candidate you support: |
|
| Comments: |
|
|
I am willing to work for Democrates: |
|
All Donations are nonrefundable.
All Donations are in US Dollars.
All Donors information is strictly confidential and will not be shared with third parties.
|
