Financial Contributions:

                I wish to financially support placing of the Elect Our Public Defender initiative onto the ballot.  My contribution (loan) will be used to print the petitions and collect signatures.  I understand that if this measure qualifies for the ballot and passes, I may be reimbursed, by the terms of this initiative, for all amounts which I have loaned or contributed to help bring this about.  I pledge the following amount: 

$0 $10 $25 $50 $99 $100 $150 $200 $250 $500 $750 $1000 Contact Me Other

First Name:

Last Name:

Company/Organization:

Full Mailing Address:

City: ,   State:   Zip:

Please include the name of your employer:

Please indicate your occupation: 

These are required by the FPPC and must be reported for contributions of $100 or more.

I will make the contribution in the following manner (Choose as many as appropriate):

I will make an online contribution I will send a check Please invoice me Please contact me

If you would like to make an on-line contribution, please click here:
 

Please send checks, with a copy of this form, to Elect Our Public Defender, P. O. Box 71, San Jose, CA  95103.  FPPC #981348.