Donate to // Courtney for Congress

Donation Form To donate to the campaign, just fill out this form. We’re sorry it’s so complicated; most of these fields are required by law.

Personal Information

First Name

Last Name

Address 1

Address 2

City

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Phone

E-Mail

Employment Information

Employer

Occupation

To comply with Federal law, contributors are required to provide their employment information. If you are retired, please enter N/A under Employer and Retired under Occupation; if you're a homemaker, please enter N/A - Homemaker; if self-employed, please enter “Self-Employed” under Employer and describe your line of work under Occupation.

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Contributions or gifts to Courtney for Congress 2012 are not tax deductible.

Federal law requires us to use our best efforts to collect and report the name, address, occupation and name of employer of individuals whose contributions exceed $200 per election cycle.

Contributions are limited to $2500 per individual per election. The primary and general elections are separate elections, so individuals may give up to a total of $5000 for both elections.

Paid for by Courtney for Congress

Phone: (707) 961-1420
If you prefer to use your email, then send to this address.
Email: drcourtney@courtneyforcongress.org

PO Box 985, Mendocino, CA 95460

Courtney for Congress

Ceated by Courtney for Congress.

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Contact Information

Courtney for Congress
PO Box 985,
Mendocino, CA 95460
707-961-1420