To contribute using a check: Complete and then print this page and mail it
with your check to AAP • P.O. Box 38129 • Colorado Springs, Colorado 80937
Name
Address
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Zip
Email
Federal law requires us to use our best efforts to
collect and report the name, mailing address, occupation, and employer for
individuals whose contributions exceed $200 in a calendar year. To
help comply with this law, please provide the following:
Employer
Occupation
Support Level and
Designation
A contribution now of $
A
monthly contribution of $
A
quarterly contribution of $
Please use my contribution to promote
The Practice Agenda
The
Education Agenda
The
Science
Agenda
Payment
Please send check with your mailed application
Please sign:
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To comply with Federal
Election Commission requirements, we must confirm that the following
statements are true for all on-line contributors. Please check the
box before each statement that applies to you. Your contribution can
not be accepted unless each box is checked.
This
contribution is made from my own funds and not from those of another.
This
contribution is not made from the general treasury funds of a corporation,
labor organization, or national bank.
I am not a
federal government contractor, nor am I a foreign national who lacks
permanent resident status in the United States.
This
contribution is made with a personal check or on a personal credit card
for which I have the legal obligation to pay, and is not made either on a
corporate or business entity check or credit card or on the card of
another person.
NOTE: Contributions to AAP/PLAN are NOT deductible for
federal income tax purposes.
