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: __________________________________________