JACPAC Membership and Donation Form
Membership Level
For donations only, enter amount here: (Note: please do not select membership AND enter an amount here unless you are adding extra to your membership, i.e. $250 membership + $100 = $350 total.)
* required field
Title
First name *
Last Name *
Address *
City *
State *
Zip *
Country *
Email *
Telephone *
Cell Phone
Fax
Credit Card Type *
Credit Card Number *
Expiration Date *
Occupation *
Employer *

Federal election law requires political committees to report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $200. According to the law, JACPAC cannot accept corporate contributions. Membership, gifts, or other payments to JACPAC are not deductible as charitable contributions for federal income tax purposes.

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