If you are retired, please enter "retired" for both entries below. If you are not employed, please enter "none" for both.
Please enter your name as you would like it appear on the co-host list. (Example: "Mary and Bob Smith")
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(The amount below will be charged to your credit card every month on this day, ending before Election Day 2009. You will make a total of 6 payments.)
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$100 | $250 | $500 | $1000 | Other $ |
Note: Only click this button once, otherwise your payment may be processed twice.