Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

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Phone *

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Today's Date *

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I will help Theresa with:

Display Theresa's Yard Sign

Talk to voters

Host a Meet n Greet

Add my name to Endorsements

Donation Amount *

The Maximum donation for the Clean Elections Program is $500 per person.

$500

$250

$100

$50

$25

$10

Sworn Statement *

By checking this box, I am making a contribution for purposes of the Arizona campaign finance laws, and swearing under the penalty of perjury that the following statements are true and accurate: I am 18 years or older, and I am a U.S. citizen or permanent resident alien; this contribution is made from my own funds, and not from the funds of any other person (including the general funds of a corporation or labor organization); and the funds are not provided to me by another person for the purpose of making this contribution.

I affirm (required)