Confirm Eligibility                                                                                                      

I confirm that the follow statements are true and accurate:

- I am not a foreign national who lacks permanent residence in the United States.
- I am not a Federal government contractor.
- This contribution is made from my own funds, and not those of another.
- This contribution is not made from the funds of a corporation or labor organization.
- This contribution is made on a personal credit card or debit card for which I have the legal obligation to pay, and is not made either on a corporate or business entity card or on the card of another person.
- I am at least eighteen years old.

Employment Information (required information)                                                                 

Full Name:  
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 a homemaker, please enter N/A - Homemaker; if self-employed, please enter "Self-Employed" under Employer and describe your line of work under Occupation.