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Donations - Secure Online Donation Form

Campaign/Fund Information
Campaign/Fund * WLRA Political Action Committee
or Select a Different Fund
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Donation Information
Donation Amount *
Payment Method * Credit Card
Personal Donations Only *
Organizations are prohibited from making contributions (direct or indirect) to candidates, candidate committees, PACs, and political parties. Therefore all donations to support WLRA's Political Action Committee MUST be submitted in the form of either cash, a personal check or personal credit card.
Donor Comments
Donor Information
First Name *
Middle Name
Last Name *
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Organization
Email *
Address *
Address Cont.
City/Town *
Country *
Location
Postal Code*
Phone *
Billing Information
[ Click here if billing address is the same as donor address ]
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Organization 
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Address Cont.
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Country *
Location
Postal Code*
Billing Phone *

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