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Make Checks payable to Prairie PAC and send to address below.



Name: ______________________________________________________________


Address: ___________________________________________________________


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Occupation: ________________________________________________________


Employer: __________________________________________________________


Home Phone: _______________________ Work Phone: ___________________


Email: _____________________________________________________________



Paid for by Vermilion County Democratic organization and authorized by Prairie PAC.

Prairie PAC 
P.O. Box 2002
Springfield, IL 62705

Please fill in all information. Federal law requires political committees use their best efforts to report the name, mailing address, occupation and name of employer for each individual whose CONTRIBUTIONS AGGREGATE IN EXCESS OF $200 IN AN ELECTION CYCLE. Candidates for federal office are prohibited from accepting corporate contributions. Contributions are not tax deductible on federal returns.