VAMPAC Contribution

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* Mandatory fields
*First name
*Last name
*VAMPAC Contribution ($USD)
*Company Name
*Zip Code
*Phone Number
In case we have questions
*Place of Employment
If Individual (Put n/a if company)
*Location of Employer
If Individual (Put n/a if company)
If Individual (put n/a if company)
*Primary Business
If Company (put n/a if individual)
*Are you a U.S. Citizen or Have a Valid Green Card
*Local Chapter*
*If you would like to designate your contribution towards multiple chapters, please check them. Your contribution will be equally divided between the chapters selected.
*I authorize the VMLA and my local chapter to use my name and level of giving in promotional material

The amount contributed, or the refusal to give, will not benefit or disadvantage any person.

All Fields are required to be filled out by the State Board of Elections

  4490 Cox Road, Glen Allen, VA 23059 | Phone (804) 819-4746 | 

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