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Your information

First Name

Last Name

Date of Birth Liquid error: custom_values.date_of_birth is not a valid form field for Donation.

Country

Billing Address

City

Postal code

Phone

Send email updates

Employer

Occupation

Law requires we ask for your employer and occupation. If you don't have an employer or are retired, put N/A, and if you are self-employed put "self-employed" in employer and describe your occupation.

This is a contribution from a business.

Donation

Contributions are not tax deductible.

Amount

$25

$50

$100

$250

$1,000

$2,500

Other $

Credit card number

Expiration

CVC

I understand that my payment is being made to Democracy Engine, who accepts the responsibility of distributing the funds to my designated recipient(s). My card or bank statement will show a payment to “Democracy Engine” and if there are any issues or discrepancies with the payment or I wish to revoke the payment, I can contact Democracy Engine at [email protected].