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
44 Summerfield Street
Thousand Oaks, CA 91360
