Enter the Number of Tickets
Platinum	$2500	x =	$
Gold	$1000	x =	$
Silver	$500	x =	$
Bronze	$250	x =	$
Individual Ticket	$100	x =	$
Red Clay Rate	$50	x =	$
$20.12 Rate	$20.12	x =	$
Order Total: $

Billing Information First Name Last Name Address City State ALAKAZARCACOCTDCDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Zip Country United States Email Phone Number Employment Federal regulations require that all contributors provide their employment information. If you are not employed, enter 'none' in the occupation and employer boxes. Employer Occupation		Credit Card Visa   American Express MasterCard   Discover Card Number Expiration date Month 010203040506070809101112  Year 2023202420252026202720282029203020312032 Comments 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.

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