VAMPAC Contribution

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Donation

* Mandatory fields
*First name
*Last name
*Email
Phone
 VAMPAC Contribution ($USD)
*Company Name
*Address
*City
*State
*Zip Code
*Phone Number
In case we have questions
*Place of Employment
If Individual (Put n/a if company)
*Location of Employer
If Individual (Put n/a if company)
*Occupation
If Individual (put n/a if company)
*Primary Business
If Company (put n/a if individual)
*Are you a U.S. Citizen or Have a Valid Green Card
*Local Chapter
*I authorize the VMLA and my local chapter to use my name and level of giving in promotional material
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The amount contributed, or the refusal to give, will not benefit or disadvantage any person.

All Fields are required to be filled out by the State Board of Elections


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