$10__$25__$50__$100__$250__$390___Other- $__________

Include the following:

-First & Last Name
-Address
-Phone
-Occupation (required)
-Employer (required)

Mail contributions to:
Vote Chuck Gray
7461 E. Ivyglen Street
Mesa Arizona 85207

(max contribution allowed by law is $390 per person or $780 per couple - both must sign check)