Change the Face of Power!

Please print this page and mail it with your check.

Make checks payable to LILLIAN'S LIST of NC and mail to:

304 East Jones Street, Raleigh, NC 27601.

Admission                  $50    __________

Friend                         $100  __________
Partner                       $250  __________

Patron                         $500 _________           

Sustainer                     $750  _________

Bronze Trailblazer      $1000_________

Silver Trailblazer         $2000_________

Gold Trailblazer          $3000_________

Platinum Trailblazer   $4000_________

NAME ________________________________________________________________________________

ADDRESS _____________________________________________________________________________

CITY ___________________________ ZIP ____________ PHONE __________________

E-MAIL__________________________________________ FAX ___________________

OCCUPATION________________________________

EMPLOYER __________________________________

Contributions of $50 or more include membership in LILLIAN'S LIST of NC. Contributions are not tax deductible. Corporate checks cannot be accepted. NC law requires political committees to report the name, mailing address, job title or profession, and name of employer or employer's specific field for each individual whose contributions aggregate is in excess of $50 in an election cycle. Paid for by Lillian's List of North Carolina, Inc., and not authorized by any candidates. While the General Assembly is in regular session, no individual registered as a lobbyist under Article 9A of Charter 120 of the General Statues may make a contribution to Lillian's List.