PATRICK LEE GIPSON 4 ASSEMBLY 2024 - Online Contributions by eFundraising Connections

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Hidden Hills Event

Thursday, April 25 2024

1 Contribution

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$5,500

VIP Victory Committee
$2,500

Hidden Hills Co-Host
$1,000

Dinner Sponsor
$500

VIP Couple
$250

Per Couple
$150

Per Person
$ Other

Please select ticket or contribution amount(s)

Please select an even decimal contribution amount if giving as a couple.

2 Personal Information

Phone

First Contributor

First Name

Last Name

Company Name

Company Type

PAC ID

True

Responsible Officer First Name

Responsible Officer Last Name

I agree to the following statements:

Responsible Officer is the Name of Individual with Primary Responsibility for Approving this Contribution

Second Contributor

First Name

Last Name

Joint Address

Address

City

State

Zip

First Contributor

I am retired

Employer

Occupation

If you are retired, please put: Occupation: Retired, Employer: None

If you are unemployed, please put: Occupation: Unemployed, Employer: None

If you are a stay-at-home parent, please put: Occupation: Stay-at-home parent, Employer: None

If you are self-employed or an independent contractor and do business under your first and last name, please put: Occupation: <describe your business>, Employer: First and Last Name

If you are self-employed and do business under a business name, please put: Occupation: <describe your business, i.e., "photographer">, Employer: The name that people put on checks to your business, i.e., "Jake's Discount Photography"

If you are employed by a company, please put Occupation: <describe your job title, i.e., "Director of Sales">, Employer: <the name of your employer>.

Second Contributor

I am retired

Employer

Occupation

If you are retired, please put: Occupation: Retired, Employer: None

If you are unemployed, please put: Occupation: Unemployed, Employer: None

If you are a stay-at-home parent, please put: Occupation: Stay-at-home parent, Employer: None

If you are self-employed or an independent contractor and do business under your first and last name, please put: Occupation: <describe your business>, Employer: First and Last Name

If you are employed by a company, please put Occupation: <describe your job title, i.e., "Director of Sales">, Employer: <the name of your employer>.

3 Payment Method

Credit Card Number

MM/YY

Security

CVC on Visa/MasterCard/Discover is a 3 digit code on the back of the card. CVC on AMEX is a 4 digit code on the front of the card.

My credit card address is different than my home address.

CC Zip

Routing Number

Account Number

This is the custom employment information requirements message

Please select a contribution amount

4 Event Details

I plan on attending the event.

# Of Guests

Guest names

Comment

Please click the reCAPTCHA checkbox

Only use the above payment option(s) for individual contributions. Contribute by credit card for corporate or couple donations

By contributing you agree to the terms and conditions.

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Please input a value between $5.00 and $5500.00

Iterations may not exceed 32000

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Number of Weeks

Number of Months

Number of Quarters

Number of Years

PayPal accepted

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Apple Pay accepted

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