YES, JOHN, I want you to become my Governor for Washington State and I will support your Primary Election Campaign with my contribution of: $ ______________ (please enter amount).

PLEASE READ AND FILL OUT THE BELOW BEFORE MAILING OR YOUR CONTRIBUTION CANNOT BE ACCEPTED.

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NOTE THAT CONTRIBUTIONS GIVEN AND MADE OUT TO JOHN W. AIKEN, JR. CAMPAIGN COMMITTEE ARE NOT TAX DEDUCTIBLE AS CHARITABLE CONTRIBUTIONS FOR FEDERAL INCOME TAX PURPOSES.

Under Washington State Public Disclosure Commission code contributions over $25.00 must contain the name and the full address of the individual contributor and contributions over $100.00 must also contain the name and the full address of the individual contributor plus the individual contributor’s occupation and employer’s address.  Political Action Committees, unions, corporations, and other business entities that reside in Washington State can contribute to a campaign and must give their name and full address. Contributions cannot exceed $1,400.00 in an election cycle (primary or general election) and $2,800.00 in a complete election.  Contributions cannot be accepted from foreign nationals or enterprises, non U.S. citizens without “green cards”, outside of Washington State corporations or business entities, labor unions with less than ten members in Washington State, and any political committees that has not received at least $10.00 or more from at least ten Washington State registered voters in the preceding 180 days.                                         

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  PLEASE PRINT

Name of Contributor (needed when donation is $25 or more):

Occupation of Contributor (needed when donation is $100 or over):

Full Address of Contributor (needed when donations is $25 or more):

Contributor’s Employer (needed when donation is $100 or over):

Employer’s Address (needed only if donation is $100 or over):

___ My personal check is enclosed. (Please make check payable to JWACC).

___ Please charge my personal credit card:___VISA, ___MASTERCHARGE, ___AMERICAN EXPRESS,___DISCOVER.

My Card Account Number is__________________________________________________

and its expiration date is___________________________________________(month/year)

My signature_______________________________________________________________

John W. Aiken, Jr. Campaign Committee
Post Office Box 250, North 312C LeFevre Street
Medical Lake, Washington 99022-0250