To make a contribution to the ongoing work of The American Independent Party print and fill out the form below. Make your check or money order payable to:

The American Independent Party

and mail to:

AMERICAN INDEPENDENT PARTY
Charles Deemer, Treasurer
21225 Talisman
Torrance, CA 90503

Please include your occupation and the name of your employer with contributions of $100 or more. State and federal laws require occupation/name of employer to be reported on donations over $100.00.

The American Independent Party is recognized by the California Secretary of State, with a registered I.D. #742371

CONTRIBUTION FORM

Name: _________________________________________

Address: _______________________________________

City/State/Zipcode: _______________________________

Telephone: _____________________________________

E-Mail: ________________________________________

Occupation: ____________________________________

Employer: _____________________________________