Please print this page, fill in ALL fields and send this form with regular postage to:

Douglas County Democratic Party, PO Box 2857, Parker, CO 80134

Your Contact Information:

Name	_____________________________________________________________
Address	_____________________________________________________________
City	________________________________ State _______ Zip _____________
Phone	________________________________
Email	_____________________________________________________________
Employer	_____________________________________________________________
Occupation	_____________________________________________________________

Individual tickets are $75; a table of eight is $560

Number of Individual Tickets ________    or number of Tables ________

Purchase tickets to the O'Clinton O'Carter Dinner by credit card:

Amount	$_________________	☐ Visa ☐ MasterCard ☐ Discover
Card #	_____________________________________________
Expires	__________________	CSC Code	____________

Purchase tickets to the O'Clinton O'Carter Dinner by check:

     Your check for $________________  made payable to Douglas County Democratic Party.

Please sign below:

Your Signature

_____________________________________________________

Contributions are not tax-deductible for federal income tax purposes.