Riverhead Democratic Committee

To contribute, print and complete this form, make check payable to Riverhead Democratic Committee and mail to:

Riverhead Democratic Committee
Attn: James "Butch" Langhorn, Chairman
P.O. Box 363
Calverton, NY 11933

Dear Butch:

I want to continue to affirm the importance of America's political system and to help elect Democratics to provide bold leadership.

Name ________________________________________

Street ________________________________________

Town & Zip ___________________________________

Phone _______________________________________

Check enclosed in the amount of $ _______________