CONTRIBUTION FORM
Please print this page, fill in, and send with your check (made payable to "Christine Smith for President") to:

Christine Smith for President

15400 W. 64th Ave., E9-105

Arvada, Colorado 80007
 

COMPLETE:
NAME (First, Middle, Last):______________________________________________________

ADDRESS:__________________________________________________________

CITY_________________________ STATE______ ZIP______________________

HOME PHONE_______________________________________________________

EMAIL_____________________________________________________________

YOUR EMPLOYER:___________________________________________________

YOUR OCCUPATION:________________________________________________

WORK PHONE______________________________________________________

Would you like us to mail you a bumper sticker for your vehicle(s)? ____________

Would you like to be placed on our campaign news email list? __________________

Enclosed is my check payable to CHRISTINE SMITH FOR PRESIDENT in the amount of $_____________

PLEASE SIGN BELOW:
I designate my contribution to CHRISTINE SMITH FOR PRESIDENT as folllows, the first $2,300 for the 2008 Libertarian nomination, and any additional amount that I contribute up to $2,300 for the 2008 general election. I make this contribution with my personal funds and not with funds provided by any other person.

Signature_____________________________________________________________

(Second Signature, required for joint accounts)_____________________________________________________________

Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and name of employer of individuals whose contributions exceed $200 in an election cycle.

An individual may not contribute more than a total of $2,300 per election to the committee (the Libertarian nomination and the 2008 general elections are separate elections). Couples may contribute $4,600 for the primary and general elections, respectively. Federal PACs may contribute $5,000 for each election.

Federal law prohibits contributions to the committee from the general treasury funds of a corporation, labor organizations or national banks (including corporate or other business entity credit cards), from any person contributing another's funds, from a Federal government contractor, or from a foreign national who lacks permanent resident status.

Contributions to Christine Smith for President are not tax deductible

PAID FOR BY CHRISTINE SMITH FOR PRESIDENT