Contribute *Print this page and mail to address below* Contribute to our efforts - SUPPORT THE CAUCUS OF COLOR Friends of Caucus of Color - $150.00 Caucus of Color Trailblazer - $75.00 Caucus of Color Pioneer - $50.00 Name: ___________________________________________________________ Address:__________________________________________________________ City/State/Zip:______________________________________________________ Employer: ________________________________ Occupation: ______________________________ Home Phone: _____________________________ Office Phone: _____________________________ Fax Phone: _______________________________ Email: ___________________________________ Signature: ________________________________ Date: _______________________ Your contribution is not tax-deductible as a charitable contribution for Federal income tax purposes.Federal Election law requires political committees to report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $200 in a calendar year. Your contribution will be used in connection with sustaining the Caucus of Color and the New York State Young Democrats and is subject to the limits and prohibitions of the Federal Election Campaign Act. *Print this page and mail to address below* Please make checks payable to: New York State Young Democrats List "Caucus of Color" in the memo line 60 Madison Avenue, 12th Flr. NY State Democratic Headquarters New York, NY 10010 Phone and Fax: (646) 530-8308 Email: info@nycaucusofcolor.org