AIDS PAC Contribution Form

(Please print and fill out this form completely and mail with contribution to
American AIDS Political Action Committee, 1224 M Street, NW, Suite 300, Washington, D.C. 20005

Contributor’s Name ______________________________________________________

Address _______________________________________________________________

City ________________________________________ State ______ Zip ___________

Phone _________________________ Business Phone ________________________

E-mail ___________________________________ FAX ________________________

Occupation ____________________________________________________________

Employer ______________________________________________________________

 Personal Check (payable to AIDS PAC)        Visa        Mastercard

Card number ______________________________________ Expiration date ________

Signature _______________________________________________________________

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