Please complete the form below, print, and mail this form with your check to:
Halfmoon Republican Club
91A Woodin Road
Halfmoon, NY  12065

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Yes, I would like to contribute to the
2009 Halfmoon Team!

 
   First Name: Last Name:
 
   Address 1:
 
   Address 2:
 
   City   *State:                    *Zip:
       
 
   Phone:      Cell Home Best Time to Call:
 
   Email:
 

Please make checks payable to Halfmoon Republican Club.
Political contributions are not tax deductible.
 

  Any assistance you can provide would be very much appreciated. 
Thank you.

* FUNDS RECEIVED IN RESPONSE TO THIS SOLICITATION WILL BE SUBJECT TO FEDERAL,
STATE AND LOCAL CONTRIBUTION LIMITS, REPORTING REQUIREMENTS AND/OR RESTRICTIONS.