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Oregon election law requires occupational information for each individual contributor.

For Employment Status:

If you are self-employed, indicate “Self-Employed.” If you are not employed, such as a homemaker, student, retired person, or a volunteer, indicate “Not Employed.”

If you are employed, the employer (name, city, and state where located) must also be provided. If you are self-employed, indicate “Self-Employed.” If you are not employed, such as a homemaker, student, retired person, or a volunteer, indicate “Not Employed.”

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First Name:

Last Name:

Email:

Phone:

Address:

Address 2:

City/Town:

State:

Zip Code:

Occupation:

Employer:

Employer City and State:

Employment Status:

I will make an online contribution.

I will mail this contribution.

Credit Card Number:

Expiration Date: *

CVV:

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