Libertarian Party of Georgia - Smaller Government

1. Contact Information

If you prefer to join, renew, donate or pledge to the Libertarian Party of Georgia via mail, please click here to download and print the mail-in form.

If you prefer to donate or pledge to the party, please click here.

Salutation

First Name *

Middle

Last Name *

The address entered below must match your credit card billing information.

Address *

Address 2

City *	State *	Zip/Post *
Country

Email Address *

Phone Number *

I give permission for my name and city to be displayed at www.LPGeorgia.com as a recent member.

2. Employment

Note: Federal law requires us to report the name, mailing address, occupation and employer for each individual whose contributions exceed $200.00 in a calendar year. State law requires us to report the same information of any person making a contribution of $101.00 or more in an election cycle. Contributions are not tax deductible. Contributions from corporations are not allowed.

Employer *

Occupation *

If you are not employed, enter “none” in the occupation and employer boxes.

3. Select an Amount *

One Time Donation Recurring Donation (double-click)

$25 - Basic Membership

$100 - Sustaining Membership

$250 - Sponsor Membership

$500 - Patron Membership

$1000 - Lifetime Membership

other: $

4. Payment Information

Name as printed on card *	Security Code * What’s this?
Card Number (no dashes or spaces) *	Expiration *

5. Oath or Affirmation

"I do not believe in or advocate the initiation of force as a means of achieving political or social goals."

Yes, I sign this oath or affirmation
No, I do not sign this oath or affirmation

Those who choose not to sign the party pledge are deemed subscribers rather than members. They receive all the same communication and service as members, but are not eligible to be delegates to the Georgia or national conventions.

6. Confirm Your Eligibility

Federal law requires all online contributors to confirm that the following statements are true and accurate. If you cannot confirm each statement, you are not eligible to contribute to the Libertarian Party of Georgia.

1. This contribution is made on a personal credit or debit card for which I have the legal obligation to pay, and is made neither on a corporate or business entity card nor on the card of another.

2. I am a United States citizen or a lawfully-admitted permanent resident.

3. I am making this contribution with my own personal funds, and I will not be reimbursed by anyone for this contribution.

4. I am not a federal government contractor.

5. I am at least 18 years of age.

* By checking this box, I confirm that each of the above statements is true and accurate.

7. Comments

If you would like to make any comments, or if you are renewing more than one membership with this form, you may include those comments or additional names here. If we have any questions, we'll contact you using the information you provided.

If you were referred by a current member in good standing to receive a FREE 50th Anniversary Edition of "Atlas Shrugged", please enter that member's name here.

7. Are You Human?

In order to protect you and others from the misuse of your credit card information, we have implemented a security question.

What is 40 + 20?