2021 CONTRIBUTION FORM

1 SELECT YOUR LEVEL(S) OF CONTRIBUTION

COMPLETE PAYMENT INFORMATION3 INSTRUCTIONS FOR RETURN4ON REVERSE YOUR INFORMATION2

YOUR SUPPORT MAKES THE DIFFERENCE

We are truly grateful for each donation

we receive, regardless of size and

frequency. Thank you for your support.

CLUB FOR GROWTH PAC ENDORSED CANDIDATES

FEDERAL CANDIDATE CONTRIBUTION LIMITS

$5,800 MAXIMUM

YOUR DONATION TO CLUB FOR GROWTH PAC

$($5,000 maximum per calendar year)

YOUR DONATION TO CLUB FOR GROWTH

$(amount not limited)

Monthly recurring contribution

Corporate contribution

YOUR DONATION TO CLUB FOR GROWTH ACTION

$(amount not limited)

Monthly recurring contribution

Corporate contribution

$_____________ Mo Brooks (AL-SEN) “Mo Brooks for Senate Committee” $5,800 maximum

$_____________ Ted Budd (NC-SEN) “Ted Budd for Senate”$5,800 maximum

$_____________ Adam Laxalt (NV-SEN) “Laxalt for Senate” $5,800 maximum

$_____________ Mike Lee (UT-SEN) “Friends of Mike Lee Inc” $5,800 maximum

$_____________ Josh Mandel (OH-SEN) “Citizens for Josh Mandel” $5,800 maximum

$_____________ Rand Paul (KY-SEN) “Rand Paul for U.S. Senate”$5,800 maximum

YOUR DONATION TO SENATE CANDIDATES

$_____________ Eric Burlison (MO-07) “Eric Burlison for Congress” $5,800 maximum

$_____________ Max Miller (OH-16) “Max Miller for Congress” $5,800 maximum

$_____________ Alex Mooney (WV-02) “Alex Mooney for Congress” $5,800 maximum

$_____________ Chip Roy (TX-21) “Chip Roy for Congress” $5,800 maximum

YOUR DONATION TO HOUSE CANDIDATES

LEGAL DISCLAIMERS

Donations to Club for Growth are not deductible as charitable contributions for Federal income tax purposes and may be used for political purposes such as supporting or opposing candidates. No funds will be earmarked or reserved for any political purpose. Contributions from foreign nationals (non-Green Card holders), government contractors and national banks are prohibited.

Donations to Club for Growth PAC and Club for Growth Action or to Federal candidate campaign committees are not deductible as charitable contributions for Federal income tax purposes. Contributions from, foreign nationals (non-Green Card holders), government contractors and national banks are prohibited. Contributions from corporations to Club for Growth PAC or federal candidate campaign committees are prohibited.

Contributions made to the Club for Growth PAC directly will be spent for Club PAC activities and programs as the PAC determines within its sole discretion. Contributions made directly to the PAC will not be earmarked for any candidate. All contributions are voluntary and you may refuse to contribute without reprisal.

Club for Growth Action is an independent expenditure committee established by the Club for Growth. Your contribution to Club for Growth Action affirms your membership in the Club for Growth.

*Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and employer of individuals whose contributions to candidates or the Club for Growth PAC, Club for Growth Action or to an individual candidate campaign committee exceeds $200 in a calendar year.

3 COMPLETE PAYMENT INFORMATION

4 INSTRUCTIONS FOR RETURN

FOR QUESTIONS OR MORE INFORMATION, PLEASE CALL US AT 202-955-5500

2001 L St. NW, Suite 600 Washington, DC 20036

MAIL THIS FORM TO:

202-955-9466

FAX THIS FORM TO:

Please make your check(s) payable to the campaign committee name listed for each candidate or entity on front of this form. For questions, call a Club for Growth team member at 202-955-5500 or email at hello@clubforgrowth.org

VISA MASTERCARD AMEX DISCOVERCREDIT CARD

CHECK(S) - Enclosed

Credit Card Number

Amount(s) Indicated on front:

Name on Card

Expiration Date

CVV/Sec. code

2 YOUR INFORMATION

Signature

Amount(s) Indicated on front:

Name/Company ___________________________________________________________________________________

Mailing Address ___________________________________________________________________________________

City, State Zip ____________________________________________________________________________________

Phone ____________________________________ Email __________________________________________________

* Occupation ______________________________ * Employer _____________________________________________

Paid for by Club for Growth PAC and not authorized by any candidate or candidate’s committee. 202-955-5500