To contribute to "People for Pat Ryan" by check or money order, please print
this page, and fill it in completely. Mail this form and your contribution to:

            People for Pat Ryan

            P. O. Box 128

            Burtonsville, MD 20866

Please make your check or money order payable to: "People for Pat Ryan"
 
We cannot accept anonymous contributions. Law requires that such contributions be
paid over to the Treasurer of the State of Maryland.


Name:__________________________________________________

Street address:___________________________________________
                                                                                            Apt. Number

__________________________________________________________
City                                         State         Zip

Email:__________________________________________________

Phone:__________________________________________________

Date of contribution:__________________________________________

Amount of contribution:________________________________________


_____ I would like to volunteer for the campaign. Please contact me about volunteer opportunities.


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