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YES, I want to help the WDC build a broad network of citizens committed to pro-democracy reform.  Enclosed is my membership contribution.

I am a ___ New or ____ Repeat Donor  

Name(s): _________________________________________________

Address: _________________________________________________

City/State/Zip: _____________________________________________

Phone: ___________________________________________________

Email: ____________________________________________________

_______ Alert me to new campaign finance reform developments via email.

Enclosed is my check ______ or credit card ______ donation

$250 ______ $100 ______ $50 ______ $35 ______ Other $ ______

Visa ______ or Mastercard ______

Name on Card: _____________________________________________

Card Number: ___________________________ Exp. Date: ______

CVV Number: ______ (3-digit number on back of card)

PLEASE NOTE: Donations to the Wisconsin Democracy Campaign are tax deductible.

Mail completed form to:

Wisconsin Democracy Campaign
210 N. Bassett St., Ste. 215
Madison, WI 53703

Thanks so much for your generous support!