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Donation Form

San Bernardino Democratic Luncheon Club Donation Form

San Bernardino Democratic
Luncheon Club
P.O. Box 451
San Bernardino, CA 92402


Please provide the following information:

Name: __________________________________________
Address: __________________________________________
City: __________________________________________
State: __________________________________________
Zip: __________________________________________
Day Phone: __________________________________________
Evening Phone: __________________________________________
E-mail: __________________________________________
Occupation: __________________________________________
Employer: __________________________________________
Donation $: __________________________________________
Signature: __________________________________________