728 PAC Contribution Form

YES, I'LL JOIN THE STAND UP,

FIGHT BACK CAMPAIGN!

www.IATSEPAC.net

Please print clearly and complete all information.

Name*

First NameLast Name

LOCAL NUMBER*

HOME ADDRESS*

Street Address

Street Address Line 2

CityState

Zip Code

EMPLOYER*

If you have multiple employers, please use “Self-Employed” or use your current employer

TITLE/OCCUPATION

Please do not abbreviate

PHONE*

Format: (000) 000-0000.

EMAIL*

example@example.com

Signature*

DATE*

Date

By contributing to the PAC using the link below, I acknowledge that this contribution is made based on my understanding that participation in IATSE PAC is voluntary and not a condition of membership in the union or employment. IATSE PAC is a federally registered political action committee, and the contributions it receives are used to support federal and state candidates and committees for the advancement of our Union. No part of my contribution will be used to pay administrative expenses of the PAC. I understand that the contribution guideline is a suggestion, and that I may contribute more, less, or nothing without favor or fear of reprisal. Federal law requires IATSE PAC to report the name, mailing address, occupation and employer of individuals whose aggregate contributions exceed $200.00 in a calendar year. Contributions are not deductible as charitable contributions for federal income tax purposes. IATSE PAC may only accept contributions from US citizens or valid green card holders.

Acceptance of disclaimer*

I accept these terms.