BlueWaveNJ and Ceasefirenj Blue Pumpkin Ball Form

NJ ELEC requires disclosure of contributions and employer information. Contributions are not tax deductible.
*State law requires us to use our best efforts to collect the name, mailing address,
occupation and name/address of employer of anyone who contributes to BlueWaveNJ and CeasefireNJ.

Registration Information Form

*First name:

*Last Name:

Phone:

* Street:

*City:

*State:

*Zip:

*Employer:

*Employer Address (Number and street):


Employer (City, State, Zip*):	*Occupation:

This information is needed for the Blue Pumpkin Ball Committee

I / We would like to be seated with:
	Email:		Please add me to the BlueWaveNJ/CeasefireNJ email list to receive occasional updates about important political issues.

(Just click once - it takes a few seconds to process)

*Required information