1. If self-employed, please indicate your job title or profession, and the name of your business or specific field. Do not enter “self-employed.” Example: “Owner” and “J. Winchester Accounting” or “Plumber” and “Construction”

2. If retired, please enter “No job title” and “Not employed.” Do not enter “Retired.”

3. Personal debit/credit card contributions only. Business debit/credit card contributions are not permitted.

4. Contributions to the Chip for Woodfin committee are not deductible for income tax purposes.

5. By making a contribution, I confirm: I am a United States citizen or a permanent legal resident; this contribution is made from my own funds, and funds are not being provided to me by another person or entity for the purpose of making this contribution; I am at least eighteen years old; I am not a foreign national; and I am not making a contribution on behalf of any corporation, business entity, labor union, professional association, or insurance company.