The 2013 Jefferson-Jackson Dinner - Democratic Party of Georgia

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Employment

Federal regulations require that all contributors provide their employment information. If you are not employed, enter 'none' in the occupation and employer boxes.

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Tickets

Number of tickets:

x $200 = $

Friends of the Party:

Gold $1500 = 6 tickets plus your name in the program $
Silver $1000 = 4 tickets plus your name in the program $
Bronze $500 = 2 tickets and your name in the program $

Order Total: $

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Legal Compliance

Check this box to confirm that the following statements are true and accurate:
1) I am a United States citizen or a permanent resident alien.
2) This contribution is not made from the general treasury funds of a corporation, labor organization or national bank.
3) This contribution is not made from the treasury of an entity or person who is a federal contractor.
4) The funds I am donating are not being provided to me by another person or entity for the purpose of making this contribution.

If you would prefer to contribute by mail,
send a check to:

Democratic Party of Georgia
Attn: Candice Franklin
PO BOX 20442
Atlanta, GA 30325

Paid for by the Democratic Party of Georgia.
PO BOX 20442 Atlanta, GA 30325
Contributions are not tax deductible for federal income tax purposes.