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First Name

Last Name

Country

Address

City

State

Postal code

Email	Phone
Send me email updates

Employer

Occupation

Law requires we ask for your employer and occupation. If you don't have an employer or are retired, put N/A, and if you are self-employed put "self-employed" in employer and describe your occupation.

Contributions are not tax deductible.

Amount

$25 $50 $100 $250 $1,000 $2,500 Other $

Contribution rules
I have read and understand the following contribution rules: (1) GPCA must use our best efforts to obtain and submit the name, address, occupation and employer of our contributors. (2) Contributions of $100 or more which do not contain this information must be returned. (3) Contributions are not tax deductible.

I confirm that the above statements are true and accurate.