Summer Sizzle Individual

INDIVIDUAL TICKET - for Picnic & Event

Your purchase will support the Polk County Republican's Get Out The Vote efforts in the important November 2 elections.
Use this form to submit your ticket order.

1. Amount

$35 Other

2. Your information

First Name

Last Name

Country

Address

City

Postal code

Phone

Send email updates

Employer

Occupation

Law requires we ask for your employer and occupation. If you don't have an employer or are retired, put N/A, and if you are self-employed put "self-employed" in employer and describe your occupation.

Contributions are not tax deductible.

3. Payment information

Credit Card

Contribution rules - I am making this contribution with my own personal credit card and not with a corporate or business credit card or a card issued to another person. - I am at least eighteen years old.

I confirm that the above statements are true and accurate.

$35.00