Contribution Form
	Print this page and mail with check made out to:                                                                     Hammonton Democratic Club                                                                     PO Box 914                                                                     Hammonton, NJ 08037 Name________________________________________ Address_______________________________________ City__________________________________________ State_________________________________________ Zip Code______________________________________ Home Phone___________________________________ Employer______________________________________ Occupation_____________________________________ Email Address___________________________________ Federal Law requires contributors to complete the following form: I am a United States citizen or a permanent resident Yes___ No___ This contribution is not made from the general treasury of an entity or person who is a federal contractor Yes___ No___ The funds I am donating are not being provided to me by another person for the purpose of making this contribution Yes___ No___ I am at least 18 years old Yes___ No___