Please complete all fields and click on a check box beside the correct contribution amount:
First Name Last name Street Address City State Zip Code Home Phone Profession Employer
Amount (check one) $25 $50 $100 $250 $500 Other
Please complete all fields and click on a check box beside the correct contribution amount. Once completed, print this page using your browser's print button and mail with your personal check (payable to Committee to Elect Gale Adcock) to:
Committee to Elect Gale Adcock 300 Legault Drive Cary, NC 27513
North Carolina Campaign Finance law requires all campaigns to collect the name, mailing address, job title or profession, and employer for each contributor. Cash contributions are discouraged and cannot be accepted in amounts over $50. Contributions are not tax deductible for income tax purposes. Corporate contributions are prohibited