Pachyderm

A tradition for GOP women!

Members between 40-49 years old can join at a Junior Pachyderm, and members under 39 years old can join as a J-Pach. (Women only).

Who's donating

First Name

Last Name

Country

Address

City

Postal code

Phone

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Employer

Occupation

Employer Country

Employer Address

Employer City

State

Postal code

Law requires we ask for your employer and occupation. If you don't have an employer or are retired, put N/A, and if you are self-employed put "self-employed" in employer and describe your occupation.

Contributions are not tax deductible.

Amount

$1,000.00

I want to pay this in installments

Credit card number

Expires

Security code (on back)

Contribution rules • I affirm that I am making this contribution via my personal credit or debit card for which I have a legal obligation to pay, and not through a corporate or business entity card or the card of another person. • My contribution is made from personal funds, and not from the general treasury funds of a corporation, organization or national bank. • I have not received any funds from another person or entity for the purposes of making this contribution. • I am a United States citizen, or a Green Card Holder who has been lawfully admitted for permanent residence and this contribution will not be reimbursed by another person.

I confirm that the above statements are true and accurate.