ABOUT DAVID

PayPal Donation

Full Name *

First

Last *

Last

Email Address *

Phone

Currently employed?

Yes

No

Employer Details

Occupation

Mailing Address

Street Address

Apt./Building/Suite #

City

State/Province

Zip/Postal

Country

By submitting this form, I agree to the following:

I am a U.S. citizen or permanent resident in the United States of America.

I affirm that I am making this contribution via my personal funds.

I am not making this contribution in the name of another.

I am not a foreign national or federal government contractor.

Donation Amount *

$50.00

$100.00

$250.00

$500.00

$1000.00

Other amountOther amount

Donation Comments

If you are human, leave this field blank.

Scroll to Top