Enclosed is my campaign contribution of:

( )$2000 ( )$l000 ( )$500 ( )$l00 ( )$50 ( )$25 ( )$___________

FEDERAL LAW REQUIRES us to obtain and report the name, mailing address, occupation and name of employer of individuals whose contributions exceed $200 per election cycle.

Full Name:_________________________

Mailing Address: ______________________________________________

Employer __________________________

Check here if self-employed _____

Occupation _______________________

The maximum an individual may contribute to the campaign is $2,000 ($4,000 per couple) per election. Corporations, foreign nationals without "green cards" and minors (under 18 years of age) are prohibited from contributing. Contributions from federal government contractors are prohibited. Contributions are not tax deductible for Federal Income Tax purposes.

Check Contributions:

The contribution to Dr. Abshier for U.S. Senate Committee, drawn on check # _______ of the account named as _____________________ represents personal funds and is not drawn on an account maintained by an incorporated entity.

Signature of Contributor _________________________________

Send Checks to:

Dr. Abshier for U.S. Senate Committee
P.O. Box 16362
Portland, OR 97292