Please verify that all information is correct. All fields marked with an asterisk (*) are required.
Title: *First Name: Middle Name: *Last Name: Suffix:

Type: *Street: Unit/Apt:
*City: *State: *Zip:

Additional Information:
*Home Phone:  Ext:     *Email:
Work Phone: Ext:
*Your Employer:If self-employed, please enter the name of your business.
*Your Occupation:

Contributions to the Bill James Campaign are limited by North Carolina law to $5,000 per individual. Corporate and business contributions are prohibited. State Law requires that I gather your Name, Address, City, State, Zip Code, Company (if applicable), Occupation and phone number.

I would like to make a contribution of:

Bill James Campaign P.O. Box 2152 Matthews, NC 28106
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