YES! I want to help by making an affordable contribution to Dick's Moore re-election effort.
1. Please provide the following information:
First Name:
Last Name:
Mailing Address:
Town:
State/Zip
Telephone:
2. Please select the amount you wish to contribute:
$25 $50 $100
$250** $500** $
** For contributions of $200 and above, we are required to report your occupation and employer. 
Occupation:
Employer:
3. Please confirm the following by checking the boxes:
I am a United States citizen or a permanent resident alien. 
I am making this contribution from my own funds, and not those of another. 
I am making this contribution with my own personal check and not with a corporate check or a check provided by anyone else. 
4.  Print and mail this form with your check to:

Moore for Senate
PO Box 496
Uxbridge, MA 01569

Thank you for your contribution.

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Massachusetts Campaign Finance Laws limit contributions to $500 per candidate per calendar year ($200 for registered lobbyists). 
For contributions of $200 and above, we are required to report your occupation and employer. 
Corporate checks cannot be accepted under state law. 
Campaign contributions are not tax deductible.