General Fund

Email*

Send me updates by email(not needed for receipts)

Phone*

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* By providing your phone number, you are consenting to receive text message updates, including automated text messages, to that number from Berny Jacques Election Campaign. Message & Data rates may apply, and message frequency may vary over time. Reply "STOP" to opt out of these text message updates.

First name*

Last name*

Residential Address*

Apt, Unit, etc.

Country*

This form only accepts US addresses.

City*

State*

Zip*

Are you currently employed?*

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Employer Name

Occupation*

Occupation Note: In Florida, your occupation (below) needs to be generally descriptive, in 1 or 2 words of the type of industry you are in and not a generic job title.

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