Contribute

It takes money to reach voters, so we would greatly appreciate your financial support!  Please print the form below and send it with your check to the address indicated.  It’s very important that we receive this form with your check, in order to comply with campaign finance laws.  Thank you!

Name: _______________________________

Street Address: ________________________

                    __________________________

City: ____________________ State: _______ Zip Code: __________

Occupation: __________________________

Employer: ___________________________

Contribution amount: __________

Please print and mail this form along with your check to:        

Piedmont for Council

819 S. Washington St.

Bloomington, IN 47401

Checks should be made out to Piedmont for Council.