Campaign Contribution Form



City                                                                    State          Zip                

Phone                                       E-mail                                                      

*I would like to honor the teaching profession by contributing $___________                       
                                                                                                                                               *($5,000 max allowed)

Please feel free to publicly honor your teacher(s) by attaching names and/or
commentary that you would like me to publish on my campaign website.

Make Checks payable to:  Lee Barrios Campaign, P.O.Box 1456,  Abita Springs, LA 70420