SOMERSILLE FOR EL CAMINO HEALTHCARE DISTRICT 2024

1 Contribution

  • $2500.00

  • $1000.00

  • $500.00

  • $250.00

  • $100.00

  • $50.00

2 Personal Information

First Contributor
Joint Address
First Contributor

If you are retired, please put: Occupation: Retired, EmployerNone

If you are unemployed,  please put: Occupation: Unemployed, Employer: None

If you are a stay-at-home parent,  please put: Occupation: Stay-at-home parent, Employer: None 

If you are self-employed or an independent contractor and do business under your first and last name, please put: Occupation: <describe your business>, Employer: First and Last Name

 If you are self-employed and do business under a business name, please put: Occupation: <describe your business, i.e., "photographer">, Employer: The name that people put on checks to your business, i.e., "Jake's Discount Photography"

If you are employed by a company, please put Occupation: <describe your job title, i.e., "Director of Sales">, Employer: <the name of your employer>.

3 Payment Method

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CVC on Visa/MasterCard/Discover is a 3 digit code on the back of the card. CVC on AMEX is a 4 digit code on the front of the card.

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