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* Mandatory fields

*First Name

*Last Name

*Voting Address

*Voting City

*Voting State

*Voting Zip

Mailing Address (if different)

Please enter your mailing address if different from your voting address.

Mailing City (if different)

Please enter your mailing city if different from voting city.

Mailing Zip Code (if different)

Please enter your mailing zipcode if different from your voting zipcode.

*Email

*Phone

*Republican

I am a registered Republican in the State of California.

*CRA 14 principles

I agree with the CRA 14 principles

*Amount ($USD)

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