2016 NEGOP Booster Club Cocktail Party

http://www.negop.org

RSVP today for the NEGOP Booster Club Cocktail Party by filling out the forms below. If you have any questions please contact Sandra Koch at (402)669-1567 or sandra@jbestcompany.com.

Contribution Amount

$100 - Bronze
$250 - Silver
$500 - Gold
$1,000 - Platinum

Personal Information

First NameRequired
Last NameRequired
EmailRequired
Home AddressRequired
Home Address (line 2)
CityRequired
StateRequired
Zip/PostalRequired
Phone NumberRequired

Employment Information

EmployerRequired
OccupationRequired

Payment Information

Debit/Credit Card

Billing Information

Same as home address.
Billing Address
Billing Address (line 2)
City
State
Zip/Postal

Legal Compliance

I affirm that the following statements are true and accurate:

Federal election law requires us to obtain and report the name, adress, occupation and employer for individuals whose contributions exceed $200 in a single year.

I want to publish my name to the 2016 NEGOP Booster Club Cocktail Party giving stream! (Note: your contribution amount will not be shown)

Your donation will appear on your credit card or bank statement as "RALLY/PIRYX"

Amount:

By clicking submit you agree to our refund policy in our terms of service.

Contributions are not deductible for federal income tax purposes. Contributions from foreign nationals or minors are prohibited. Federal election law requires us to obtain and report the name, adress, occupation and employer for individuals whose contributions exceed $200 in a single year.

Paid for by the Nebraska Republican Party. Not authorized by any candidate or candidate's committee. 1610 N Street, Lincoln, NE 68508 www.negop.org 402-475-2122

This form is secured using 256-bit SSL encryption.

Piryx - The Social Giving Platform

Now fundraising is as easy as writing a blog or posting a status update and can be integrated into your website, product or mobile app. With Piryx, causes raise money online in more volume and much more effectively across the web. To learn more and create your own free account visit Piryx.com.

Piryx™