Committee to Elect Mike
Horrigan
36 Wood Avenue
Framingham, MA 01702
Yes I want to help elect Mike, an independent voice!
I have enclosed a donation check
of $____________ to support Mike Horrigan for State Representative Campaign:
Name:_____________________________________________________________
Address:___________________________________________________________
Town:_______________________________ State:_________________ Zip:_________
Phone:__________________________ Email:___________________________________
For Donations over $ 200.00 we also need the following information: (information required by State Law for contributions over $200.00 per calendar year. Maximum contribution allowed $500.00 per individual, $1,000 per couple per year. No corporate checks accepted.)
Occupation:________________________________________________________________
Employer & Address:_________________________________________________________
Please print this form and mail with check or money order to:
Committee to Elect Mike
Horrigan
36 Wood Avenue
Framingham, MA 01702