Please include an email address for an emailed receipt
If you have selected fair share (one hours pay per month) please list your hourly pay.
Please add the 'other' amount you would like deducted each pay period.
If you would like to give a one time donation with a debit/credit card, please include the card number, expiration date, and code on the back. Please also include the donation amount on the "other amount" box above.