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Last Name:

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Phone:

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Address 2:

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I will make an online contribution.
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State law requires name and address be included with political contributions.

For contributions more than $200, employer (occupation if self employed) must also be included.

A maximum of $1,000/person is allowed by state law.

If contributing via Paypal, please include the above information in the "Add special instructions to recipient" section of Paypal.