In order to keep you informed and allow you (or any of your executive, administrative or professional personnel) to receive information on our programs, special events and activities, as well as communications on top congressional races and federal election activities, we are required to maintain your signature on file, and request that you please take a moment to complete the information below.

Full Name
Title
E-mail
Company Name
Company Address
City
State and Zip Code Zip

IAAPA PAC is authorized to solicit voluntary contributions from myself only as a member of the executive and administrative personnel of my company for the following years.

OR

IAAPA PAC is authorized to solicit voluntary contributions from the executive and administrative personnel and stockholders of my company for the following years.

I understand that my company may not approve a solicitation by any other trade association for these years. (Federal law requires political committees to report the name, company, address, occupation, and name of employer for each individual whose contributions aggregate in excess of $200 in a calendar year.)

Please check below on each year that permission is granted to solicit and bill, based on the box marked above.
2016
2017
2018

Your selection does not obligate you to make any contribution to IAAPA PAC, it allows IAAPA PAC to inform you of upcoming activities.