Yes, I want to help Ayesha by making a contribution of:

$1,000____ $500____ $250____ $100____ $50____ $25____ Other____

Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and name of employer for individuals whose contributions exceed $200 for an election.

Name _______________________________________________________

Address ______________________________________________________

City ____________________________State________ Zip ______________

Occupation________________________ Employer ____________________

Telephone (H)______________________ Telephone (W) ________________

Fax ____________________E-mail ________________________________

Signature _____________________________________________________

Please make checks payable to: Nariman for Congress

Contributions to political candidates are not deductible for federal income tax purposes.
Contributions from corporations, unions, national banks and foreign nationals are prohibited.
Contribution limits are $1,000 per individual per election and $5,000 per federal PAC per election.