A Night With Fernando Dutra HomeA Night With Fernando Dutra "*" indicates required fields Name* First Last Email* Business PhoneCell PhonePhysical Address (No PO Box)* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Fernando needs your help... I endorse Fernando Dutra for Whittier City Council 2022 and you can use my name on your web site and printed materials I'm requesting a lawn sign I would like to volunteer I would like to donate in-kind services (printing, mailing, services, etc.) Because of state and federal campaign laws, you must disclose if you are employed and if so, you must state the name of your employer and occupation. Are you employed?* Yes - I'm employed. No - I'm retired or unemployed. Name of Employer Your occupation Purchase TicketsShould we save you seats at the event? Yes - I will be there! No - I will not be able to attend but here's my donation VIP Reception (Per Person) Quantity Price: $350.00 Quantity General Admission (Per Person) Quantity Price: $200.00 Quantity Enter names you are registering (one name per line)Additional Donation Amount (Optional) 3% Credit Card Fee $0.00 Total Credit Card Cardholder Name Card Details 82126
