Complete this form and print the page to mail your contribution.
YES! Add my voice to the Conscience of the Republican Party.
Devote every penny to the pursuit of limited
government, free trade
and individual liberty.
Calendar Year PAC Contribution
Amount: $ ________.__
You may contribute up to $5,000 per Calendar Year to
the PAC.
Donations in excess of $250 require that we request
your employer
and
occupation information.
Monthly Sustaining PAC Contribution Amount: $ ________.__
You may contribute up to $415 per month to the PAC
for the Calendar Year.
Monthly
donations in excess of $20 require that we request
your employer
and
occupation information. Cancel when you please. RLC On-Time
Contribution
Amount: $ ________.__
There is no limit on contributions to the membership
organization,
which may
not support candidates for federal office. Monthly
RLC Sustaining Contribution
Amount: $ ________.__
Contribute any amount automatically each month. Cancel when you
please.
Donations are not tax deductable.
(For
information on deductable opportunities, contact
our office.)
Name:
Address:
City:
State:
Zip:
-
Day Phone:
()
-
Ext:
E-mail:
@.
Employer:
Occupation:
Charge $ _____.__ to my card [ ] One-Time [ ] Monthly:
Account #
__________________________________________
Name on Card: _______________________ Exp. Date
___/___
Your Signature:
______________________________________
Check enclosed for $ _____.__ payable to [ ] RLCUSA-PAC [ ]
RLC
Mail
Contribution to: RLCUSA-PAC
PO Box 410045
Melbourne, FL 32941-0045
