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To comply with L.A. City and CA State laws, contributors are required to provide their name, address (including zip code), occupation, and employer information. Please also disclose whether you are making the contribution with a personal or business credit card.

 

First Name:*
 Last Name:*
Email:*
 Phone:
Address:*
Address 2:
City/Town:*
 State*
 Zip Code*
Occupation:*
 Employer:*

Contribution Amount   
Other Amount $:

Maximum contribution of $700 per person. A person is an individual, proprietorship, firm, partnership, joint venture, syndicate, business trust, company, corporation, limited liability company, association, committee, or any other organization or group of persons acting in concert. CA Gov’t Code § 82047. Please visit http://ethics.lacity.org to view the "Contributor Guide -2013 Elections Update" for additional regulations. 

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Brian Selem for 11th District City Council 2013
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