Contribute

*Required

First Name(s)*
 
Last Name*
 
Address*
 
City*
 
State*
 
Zip Code*
 
Telephone*
- -
 
Fax
- -
 
Email*
 
Spouse's email

NORPAC will never distribute your email address to an outside organization
 
Occupation
 
Employer
 
Self Employed
 Yes No
 
Membership Categories







$

 
Reason for Contribution
 
 *I confirm that the following statements are true and accurate:
 
  • I am not a foreign national who lacks permanent residence in the United States.
  • I am not a federal contractor.
  • This contribution is made from my own funds, and not those of another.
  • This contribution is not made from the general treasury funds of a corporation, labor organization, or national bank.
  • This contribution is made on a personal credit card or debit card for which I have the legal obligation to pay and is not made either by a corporate or business entity card or on the card of another person.
  • I am at least 18 years old.
 
Name on Card:
Card Number:
Expiration:
Security Code:
 
Contributions to NORPAC are not tax deductible.
Federal law requires us to use our best effort to collect and report the name, mailing address, occupation and name of employer of individuals whose contributions exceed $200 in a calendar year.
Thank you for your cooperation.