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: _________________________________________________________________

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

 Email: __________________________________________________________________

Enclosed is my check _______ or credit card _______ donation

$250 ________ $100 _______ $50 _______ $35 _______ Other $ ________

Visa ________ or Mastercard ________

Name on Card: _________________________________________________

Card Number: ___________________________ Exp. Date: __________

3 Digit Security Code (last 3 digits on back of card) _______________

PLEASE NOTE: Donations to the Wisconsin Democracy Campaign are tax deductible. To make a non-tax donation for advocacy purposes please write "advocacy" on this form or your check memo line. Thanks!

Mail completed form to:

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

Thanks so much for your generous support!