Enclosed is my contribution of:

[  ] $10   [  ] $50  [  ] $100  [  ] $500  Other  $ _________

Please make checks payable to: BCDCC

Political contributions and gifts are not tax deductible.

Print name _____________________E-mail _______________________
Address _______________________City ________ State___ Zip ______
Home Phone ___________________Work Phone ___________________
*Occupation ___________________*Employer ____________________
*Employer's City ________________*Employer's State _______________
* Required by PDC rules



Mail your check and this form to:

Benton Co. Democratic
Central Committee
P.O.  Box 636
Richland,  WA 99352