If you wish to contribute directly to the Dan Brady for State Representative campaign effort, please print this page, complete the form and enclose it with your donation. Thank you!

Please mail contribution to:
Friends of Dan Brady
P.O. Box 769
Bloomington, IL 61702-0769

Name:________________________________________________ Address:_____________________________________________ City:______________ State:__________ Zip: ___________ Phone:_______________________________________________ Fax:_________________________________________________ E-Mail Address:______________________________________ Employer:____________________________________________ Occupation:__________________________________________ Amount: ____ $50 ____ $150 ____ $250 ____ $500 ____ other Count on me for a monthly donation of: ______________

Friends of Dan Brady
P.O. Box 769
Bloomington, IL 61702-0769
Phone: (309) 663-4184
dan@votedanbrady.com