Enclosed is my donation of:
[ ] $10 [ ] $25 [ ] $50 [ ] $100 |
Please make check payable to "Sydney Vergis for City Council 2010".
Name:________________________________________________________________
Address:______________________________________________________________
City:__________________________________ State:_________ Zip: _____________
Home Phone:________________________ Work Phone:_______________________
(Contributor's occupation & employer information required by law)
Occupation:_______________________ Employer:___________________________
|
