Important Notice for Donations of $1,000 or More…

Hawaii state law requires us to collect the full name, mailing address, occupation, and employer of donors contributing $1,000 or more. Contributions must be made from your own funds and may not be reimbursed by any other person or entity. By submitting this form, you confirm that this donation complies with all applicable laws.

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Occupation

Employer (Company / Organization Name)

I certify that my donation is made from my own funds, is not being reimbursed by any other person or entity, and complies with all applicable federal and Hawaii state laws.

Important Notice for Donations of $1,000 or More…

PAID FOR BY “FRIENDS OF MEL RAPOZO”