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

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Porter Ranch Event

Thursday, June 27 2024

1 Contribution

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$2,500

Reception Co-Host
$1,000

Reception Sponsor
$500

VIP Couple
$250

VIP Attendee
$175

Per Couple (General Reception)
$150

General Reception Upgrade
$100

Per Person (General Reception)
$ 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

Please select a contribution amount

4 Event Details

I plan on attending the event.

# Of Guests

Guest names

Comment

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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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Time span must not be past credit card's expiration date

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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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