Thank you for contributing to the Libertarian Party of West Michigan!

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Please complete this form, make your check or money order payable to

"Libertarian Party of West Michigan", or complete the credit card information

below, and mail to:

Libertarian Party of West Michigan, P.O. Box 3685, Grand Rapids, MI

49501-3685

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Please also complete the following information:

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If you would also like to become a member of the Libertarian Party of

West Michigan, please sign below:

"I do not believe in or advocate the initiation of force as a means for

achieving political or social goals."

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PLEASE NOTE: Unless you specify otherwise, the LPWM may elect to use

your contribution for federal campaign purposes, state campaign purposes,

and/or for administrative purposes.  State law requires us to provide the

name and address of all contributors, and the occupation, employer and

work address for contributors whose total annual contributions exceed

$100.  Federal law requires us to provide the name, address, occupation,

employer and work address of all contributors whose total annual

contributions equal $200 or more.  Contributions to the LPWM are not

considered charitable contributions for federal income tax purposes, but may

be deductible for state income tax purposes. Corporate contributions are

prohibited for campaign purposes, but may be accepted for administrative

purposes. Contributions by foreign nationals are prohibited.

Paid for by the Libertarian Party of West Michigan from regulated

funds, PO Box 3685, Grand Rapids, MI 49501-3685.  Not authorized

by any candidate.