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Name *
Name
Address *
Address
We are required by law to collect this information for reporting to the Washington Public Disclosure Commission.
We are required by law to collect this information for reporting to the Washington Public Disclosure Commission (e..g. owner, CEO, retired, homemaker, unemployed, self-employed, etc.)
We are required by law to collect this information for reporting to the Washington Public Disclosure Commission.
Employer Address *
Employer Address
We are required by law to collect this information for reporting to the Washington Public Disclosure Commission.

NOTE: As a registered political committee with the Washington Public Disclosure Commission, we are required to report certain donor information for all monetary and in-kind contributions. Your information will not be used for any purposes other than for PDC reporting, as required by law.

For more information, please visit pdc.wa.gov and read “Required Contributor Information.”