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Contributions/Donations

I AM NOT SOLICITING  ANY CONTRIBUTIONS/DONATIONS AT THIS TIME AND I DO NOT AUTHORIZE ANY IN-KIND CONTRIBUTIONS FROM OTHER PARTIES, INDIDVIDUALS OR ORGANIZATIONS OTHER THAN MYSELF.

But Please spread the word about my campaign - THANKS!!!

First Name: Last Name:
Email: Phone:
Address:
Address 2:
City/Town:
State:
Zip Code:
Occupation: Employer:

Contribution Amount




$:

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