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Please print this page and review the information below prior to sending your check or money order to:

The Committee To Elect Rick Pond
P.O. Box 209
Hanover, MA 02339
Anne Allcot Treasurer 

The check or money order should be payable to The Committee To Elect Rick Pond. 

The maximum individual contribution under State law is $500 per year per candidate.

Any amount helps!

Name: ____________________________________

Address: ____________________________________________________

Employment Information

Campaign finance law requires us to collect and report your occupation and employer.

Occupation [__________________________] (Please enter "none" if not employed or enter "self" if self-employed.)

Employer [__________________________] (Please enter "none" if not employed.)

Please check this box before sending in your donation.
      [_] I confirm that the following statements are true and accurate.

1. I am a United States citizen or a permanent resident alien.
2. This contribution is made from my own funds, and funds are not being provided to me by another person or entity for the purpose of making this contribution.
3. I am making this contribution from my own personal funds and not with corporate or business funds or funds from another person.
4. I am at least eighteen years old.

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  Copyright 2009 by The Committee to Elect Rick Pond