Help elect Carolyn this November. Please print out this
form and mail it in to the address listed below along with
your donation.
Contributor
First Name:*
Last Name:*
Home
Address:*
City:*
State:*
Zip:*
Home Phone (optional):
Work Phone (optional):
Email (optional):
*This information is required by Massachusetts campaign
finance laws.
Employment
Occupation:*
Employer:*
*Massachusetts campaign finance laws require donors to
provide their employment information. Please enter
"none" in the boxes above if you are not employed.
Amount
$500
$250
$100
Other:
Individual contributions cannot exceed $500 per calendar
year. Campaign finance laws prohibit contributions from
corporations. We cannot accept bank checks or money
orders. Personal checks only. Please be aware that
contributions are not tax deductible.
Mail in Your Donation
Make personal checks payable to "The Committee to Elect Carolyn Dykema" and mail it to the
following address:
The Committee to Elect Carolyn Dykema
c/o Tara Hathaway
PO Box 6475
Holliston, MA 01746
