Contribute
Contributions will be put to use to inform the residents of the 97th House District about Jan Polizzi’s candidacy.
To contribute to Jan online, click here to visit ActBlue.com.
To contribute via mail, or in person, please print this page and mail with your contribution payable to
Committee to Elect Jan Polizzi RN
5953 Shortleaf Court
St. Louis, Missouri 63128-4306
Enclosed is my contribution of $____
Name ______________________________________________
Address _____________________________________________
City ________________________________________________
State _____________________________zip________________
Phone _______________________________________________
E-mail address (optional) _______________________________
Occupation __________________________________________
Employer ___________________________________________
Are you self-employed _______Yes ______No
Do you or your employer have a $500 contractual relationship with the state political subdivision? _____yes ______no
Missouri Law requires political committees to report name, mailing address,
occupation and name of employer for each individual/committee whose aggregate
contributions exceed $100 in an election cycle.