Constitutional Organization Of Liberty

Restoring Honor Rally
August 28, 2010 - Washington, D.C.

Name:______________________________________________________________________

Address:____________________________________________________________________

City:__________________________________________ State:__________ Zip:__________

Phone:__________________________________________________ Ext:_______________

E-mail:_____________________________________________________________________

*Occupation:________________________________________________________________

*Employer: _________________________________________________________________
 

Please reserve ______ seats for the motor coach trip to Washington, D.C., for the
"Restoring Honor Rally" at $45 per person.

[  ] Enclosed is $_____ in payment of my seat(s)
 
 

Signature:____________________________________________________________________
 

(Include the names of all members of your party on the reverse side of this form.)
 

The Constitutional Organization Of Liberty (COOL) reserves the right to reject any applicant for participation or membership or to
terminate same for due cause as determined by the Board; refund of payments subject to the discretion of the Board.

*Pennsylvania law requires that we report the name, address, occupation, and employer for each individual whose contributions
aggregate in excess of $50 in a calendar year.  Political contributions are not tax deductible.  No corporate checks can be received.
Federal limit per individual is $20,000 per year.
 
 

Paid for by Constitutional Organization Of Liberty - Greg Keiper, Treasurer