Yes, TrooperPAC, I support your efforts on behalf of public safety and law enforcement in Oregon.

Contributer # 1

NAME:

ADDRESS:

CITY: STATE: ZIP: -

PHONE: (Required) -

EMPLOYER:

ADDRESS:

CITY: STATE: ZIP: -

OCCUPATION:

Contributer # 2

NAME:

ADDRESS:

CITY: STATE: ZIP: -

PHONE: (Required) -

EMPLOYER:

ADDRESS:

CITY: STATE: ZIP: -

OCCUPATION:

Enclosed is a contribution to TrooperPAC of:

$500   $250   $100   $50   Other                     

Per Oregon State Statute TrooperPAC must report the name, address, employer and occupation of individuals and corporations whose contributions total $50.00 or more.

If you are married and place both spouse names on this form, please provide full information on both spouses.

SEND CONTRIBUTION TO:  TrooperPAC, 3905 River Road N., Suite B, Keizer, Oregon 97303-4805