You may use name (signature required)				Date
Enclosed is my contribution for: $25 $50 $75 $100 $150 $250 (Make checks payable to Friends of Pam Slater - Max. contribution $250 per person)				$
I would also like to:
	Host a breakfast or lunch to help raise campaign funds
	Volunteer to help when needed
	Place a yard sign at my home
	Make phone calls
In order to deposit all checks we must have the following information as required by local election laws:
Name:
Spouse's Name:
Address:
City:
State:			Zip:
Home Phone:		( )	Business Phone:	( )
Occupation:
Employer or Firm:
	Self Employed
Business Address: