ANCOR DC PAC Solicitation Form

Instructions

Please fill out this form to authorize the ANCOR DC PAC to send you communications. For questions, please email Elise Aguilar eaguilar@ancor.org.

Question Title

* 1. On behalf of my company, which is a member of the American Network of Community Options and Resources (“ANCOR”), I hereby authorize communication with and solicitation of the company’s restricted class (e.g., salaried, executive or administrative employees; shareholders; and these persons’ immediate families) by ANCOR and/or the American Network of Community Options and Resources Disability Champions Political Action Committee (“ANCOR DC PAC”) for the calendar year(s) signed below. ANCOR DC PAC is a multi-candidate PAC. I understand that company approval is necessary before ANCOR or ANCOR DC PAC may conduct a solicitation. I further understand that a trade association’s corporate member may give only one such authorization per calendar year, and to the best of my knowledge, my company has not given such authorization to any other federal trade association political action committee for the calendar year(s) authorized below.

Name *

Company *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number

Question Title

* 2. Please fill in your name next to each year in which you authorize solicitation. Each year authorized requires its own electronic signature and automatically expires on December 31st.

2024

2025

2026

2027

2028

Question Title

* 3. OPTIONAL: Please Choose One or More:

My organization will do its own internal ANCOR DC PAC solicitation drive – please send us supporting materials. I understand that if my organization is a certified 501(c)3 we can give ANCOR or ANCOR DC PAC permission to solicit directly from designated employees, but the organization itself cannot organize a solicitation drive.

We have attached in a document or spreadsheet the names, titles, email addresses, and home mailing addresses of our designated employees to be solicited with ANCOR DC PAC.

We will share names, email addresses, and mailing addresses of shareholders/company owners to be solicited with ANCOR DC PAC.

Question Title

* 4. I understand that federal law requires only U.S. Citizens who are ANCOR members to donate to ANCOR DC PAC, and that donations cannot come from my organization’s funds.

I understand.

Please Return Any Additional Documentation To:

American Network of Community Options and Resources Disability Champions Political Action Committee

1101 King Street, Suite 380

Alexandria, VA 22314