Contribute by check

Complete the following form, then print and mail with your check to the address below.

*Name
*Address
*City/State/Zip
*Occupation
*Employer
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 (include area code)
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*Campaign reporting laws require this information be submitted with each contribution.

CONTRIBUTION

$200 $100 $50 Other:

Please make checks payable to: Teresa Barrett for Council 2010

Print this form and mail to:

Teresa Barrett for Council 2010
ID#1286593
P. O. Box 901
Petaluma, CA 94953

Please print this page and submit with your check.

Thank you!

Email: Teresa4Petaluma@comcast.net
Phone: 707.953.0846