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PAC Donation Form

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Personal Information

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State

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Company Information

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Company State

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Contribution

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Total

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Amount Charged Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Full-Time Employees Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Part-Time Employees Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Hotel/Motel Rooms Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Restaurant Seats Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Additional Associates Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Additional Associates Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Additional Locations Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Additional Locations Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Assets Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Assets Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Additional Categories Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Number Of Additional Categories Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Additional Categories Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Additional Item 1 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information

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Tax (charged to card) Required Please enter a valid number Please enter a valid date Please enter valid credit card information

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Additional Item 2

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Additional Item 10

Payment Type

NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.

Membership Type

Primary Directory Category

Additional Directory Categories

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Secondary categories may be subject to additional fees

Number of Full Time Employees

Number of Part Time Employees

Number of Rooms

Number of Seats

Number of Associates

Number of Locations

Millions in Assets

Enhanced Membership ($50)

Annual Membership Investment $0.00

Additional Categories Cost $0.00

One-Time Application Fee $0.00

Tax $0.00

Additional Item 9

Additional Items $0.00

Annual Dues (charged to card) Required Please enter a valid number Please enter a valid date Please enter valid credit card information

Credit Card Information

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