PASS PAC Enrollment
Yes, I want to join the PASS PAC
If the information is incorrect, email PAC Executive Director John Smith (John.Smith@pass.com).
Your Latest PAC Contributions
| Year | Total Contribution Amount |
| 2018 | $175.00 |
| 2017 | $1,750.00 |
| 2016 | $1,000.00 |
How would you like to support the PASS PAC?
* Maximum annual contribution is $5,000.
Confirmation
I understand that PASS PAC is a separate segregated fund organized under the Federal Election Campaign Act and was created for the purpose of making contributions to and expenditures on behalf of federal, state, and local candidates and other committees. I hereby certify that my participation in the PASS PAC is voluntary. I have the right to refuse to contribute without reprisal. I understand that my payroll deduction will continue until revised or revoked by me in writing to the Treasurer of the PAC. I understand that the contribution levels presented are merely suggestions, that I am free to contribute any amount, and that the amount I give, or a decision not to give, will not benefit or disadvantage me. I also understand that federal law requires PASS PAC to use its best efforts to collect and report the name, address, occupation, and employer of each individual who contributes more than $200 in a calendar year. I understand that my contribution is not deductible as a charitable contribution for federal income tax purposes. I understand that I will be neither advantaged nor disadvantaged in my employment by my decision to contribute or not to contribute to the PAC and that I am free to select any level of contribution if I choose to participate. I certify that I am either U.S. citizen or a foreign national with permanent residency status in the U.S. My contribution will be made with personal funds and will not be reimbursed by any other source.
Please sign this form below and click the Submit Enrollment button:
Employee Signature: