New this year: a faster way to complete your matching-funds receipt.

Berkeley's public financing program asks contributors to sign a short receipt so your donation can be matched 6-to-1. Traditionally that meant printing, signing, scanning, and emailing it back. This form does the same thing online — fill it out, sign on your screen, and submit, no printer or scanner needed. Prefer the paper route? , print and sign it, then email it to DariaForBerkeley@proton.me.

Matching-Funds Receipt

Daria Wrubel for City Council 2026 — Berkeley Fair Elections

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Payment is made securely via ActBlue — this form creates your matching-funds receipt.

Your Contribution

Amount (USD) — Berkeley matching contributions are $10–$60

Please enter an amount between $10 and $60.

Payment type

Your Information

Last name

Required.

First name

Required.

Middle initial (optional)

Home address

Required.

Apartment / Suite / Floor (optional)

City

Required.

State

ZIP code

Required.

Telephone (optional)

Email address

Please enter a valid email.

Occupation

Required.

Employer

If not employed, enter homemaker / student / retired / unemployed. If self-employed, enter your business name and city.

Required.

Your Signature

I understand that the purpose of this contribution is to help the above-named candidate qualify for Fair Elections campaign funding as prescribed by the Berkeley Charter, Article III (Elections) and Berkeley Municipal Code Chapter 2.12 (Election Reform Act). I have made this contribution without coercion or reimbursement. I certify that I am a Berkeley resident.

Sign with your finger or mouse. By law this must be hand-drawn — there is no type-to-sign option.

✕

Signature required.

I am a Berkeley resident; I made this contribution without coercion or reimbursement.

Your information is handled securely. This form creates your official Fair Elections matching-funds receipt. Your details and signature are encrypted both in transit and in storage, then sent to the Daria Wrubel for City Council 2026 campaign and on to the City of Berkeley as the program requires. (Contribution records become public under the matching-funds program — standard for all campaign donations.)

Sending your signed receipt…

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Your signed receipt was sent

Thank you for supporting Daria Wrubel for City Council. The campaign has received your matching-funds receipt.