Campaign finance law requires us to obtain your occupation and employer.
If self-employed, enter the name of your business; if unemployed enter 'none' or 'retired'.
Please complete even if self-employed; enter 'none' or 'retired' if unemployed.
You may list my name publicly as an endorser.
Your ticket purchase constitutes a contribution divided between the listed recipients as follows:
Lateefah Simon ( - 100%)