CAHUPAC - Donate to the PAC Today!

Monthly Contribution Form

Bold items are required.


First Name	Middle	Last Name	Designations


Occupation (Required for FPPC reporting purposes)


Employer (If self employed, name of business; required for FPPC reporting purposes)


Address (Home address for personal accounts; business address for business accounts)


City	State	Zip


Phone	Fax	Email	Home Zip


Local Chapter


Payment Method

Note: Political contributions are reported to the FPPC and your name, as a contributor, will be a matter of public record.

Precious Gem Stone Contribution Levels

Please select your desired monthly contribution amount

Level	Annual	Monthly Minimum
Ruby	$250 - $499	$21/month
Emerald	$500 - $719	$42/month
Sapphire	$720 - $999	$60/month
Diamond	$1,000 - $1,999	$85/month
Diamond	$2,000 - $2,999	$170/month
Diamond	$3,000 - $3,999	$250/month
Diamond	$4,000 - $4,999	$340/month
Diamond	$5,000 - $6,000	$420/month
Other: /month

After you submit this form, we will call you to obtain your credit card or bank account information. We are not gathering this information online because we want to protect the privacy of your personal financial information.