You are welcome to contribute as often as you'd like; however, the maximum contribution per person or entity is $5,000 per election cycle.
PRINT & COMPLETE this form to submit with your contribution.
Make your check or money order ~ no cash please, payable to:
"Committee to Elect Gary M. Hosea" and mail to:
Required fields:
Name: ______________________________________________________
Address: _______________________________________________
City, State, Zip: ________________________________________________
Optional fields:
Home Phone: _____________________
Fax: _______________________
Cell Phone: _____________________
E-Mail: ___________________________________________
Provide the following information if your contribution check is drawn on a joint account with your spouse:
Contribution check #_______ is drawn on a joint account with my spouse. $_______ constitutes the amount of my contribution and $_______ constitutes the amount of my spouse’s contribution.
Contributor Signature: __________________________
Spouse’s Signature: __________________________
Committee to Elect Gary M. Hosea
G. Hosea, Treasurer; 6804 Dorita Ave Unit 201; Las Vegas, Nevada 89108.
