CONTRIBUTION FORM

Oregon Republican Mainstream

P.O. Box 2224, Wilsonville, OR  97070-2224

_____I want to help. Enclosed is my contribution made payable to: Oregon Republican Mainstream.

(Your canceled check will act as your receipt for the Oregon Political Tax Credit)

Name: ____________________________________________________________________________________

Address:____________________________________________ City, State, ZIP:__________________________

Phone:_______________________________ Occupation (required by Election Law):______________________

Name of employer (required by Election Law): _____________________________________________________

City & State of employer (required by Election Law):_________________________________________________

Email address:______________________________________________________________________________

(we promise we won’t sell or give your Email address to any group or individual)

Please print out this form and include it with your check, thank you.

Oregon Republican Mainstream Committee
PO Box 2224
Wilsonville OR 97070-2224
503-670-9353