Please
print this page, fill in ALL fields, send regular postage along with your check to:
Ron Galperin for City Council
c/o Durkee & Associates
1212 S. Victory Blvd.
Burbank, CA 91502
| Name: | _____________________________________________________________ |
| Address: | _____________________________________________________________ |
| City: | ________________________________ State _______ Zip ___________ |
| Phone: | ________________________________ |
| Email: | _____________________________________________________________ |
| Employer: | _____________________________________________________________ |
| Occupation: | _____________________________________________________________ |
Enclosed is a check for $___________ made payable to Ron Galperin for City Council.
| Your Signature: | _____________________________________________________ |
| Date: | _____________________________________________________ |
Your contribution is not tax-deductible for federal income tax purposes.