As required by state and federal law, please indicate your occupation and employer, or indicate if you are retired, self-employed, a homemaker, or unemployed.

By law, if you donate to a political campaign, you must be able to confirm that the following statements are true and accurate:

• You are not a foreign national who lacks permanent residence in the United States.
• Your contribution is made from your own funds, and not those of another.
• Your contribution is not made from the funds of a corporation or labor organization.
• Your contribution is made from an account for which you are legally responsible to pay, and is not made on a corporate or business entity account or on the account of another person.
• You are at least eighteen years old.