PAC Donation

PAA PAC

Recognition Levels:

$5,000 Governor’s Club
$3,500 Diamond Club
$2,500 Platinum Club
$1,000 Gold Club
$500 Silver Club
$250 Bronze Club
$125 Contributing Member

Name

Company Name

Address

City

State

Zip

Phone

Email

Donation Amount

Credit Card Number

Exp Month

Exp Year

Security Code

I certify that the donation I am making is from a personal card and is eligible to give such donations.

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