Complete this form and print the page to mail your contribution.
YES! I want to assist the campaigns
of any federal candidates endorsed by the RLC
in the pursuit of limited government, free trade and
individual liberty.
RLCUSA-PAC
federal candidate contribution
Amount: $ ________.___
The maximum 'hard money' contribution is $5,000 per calender
year, which will
go directly to RLC-endorsed federal election campaigns.
Preferred
candidates may be suggested, but cannot be a stipulation of your
donation.
My favorite
federal candidate is: ______________________________________
RLC
Membership Dues Category: ________________ Amount: $ ________.__
Regular Membership Dues are $30. See RLC 'Join
us' website for other options. RLC One-Time
Contribution
Amount: $ ________.___
RLC 'soft money' will support general RLC activities, but may be
designated to
assist
important state and local campaigns. There is no limit on
contributions.
My favorate
state or local candidates is: _________________________________
Donations are not tax deductable.
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
___/___
Billing Zipcode: ___________
Your Signature:
______________________________________
Check for $ _____.__ made Payable
to RLCUSA-PAC
RLC
FEC Regulations
require that we request the following
information
for RLCUSA-PAC contributions:
Your Occupation:
___________________________________
Your Employer:
____________________________________
Mail
Form and Payment to: Republican
Liberty Caucus/RLCUSA-PAC
PO Box 410045
Melbourne, FL 32941-0045
