Registration for Mission to Washington

Mission Date: Monday, May 3 - Thursday, May 6, 2021

The NORPAC Virtual Mission is a multi-day event that requires usage of Zoom and possibly other web meet software on your phone or computer. You will be contacted to provide your schedule and availability prior to the Mission.

Please Note: Last day for a refund is 30 days before Mission Date

NORPAC Mission 2021 FaceBook Page

Personal Information
Fields marked with an (*) are required.

* Title
* First Name
* Last Name
* Address
* City
* State
* Zip Code
* Email
* Verify email
* Cell Phone - -
We require a cell phone # so that we can contact you on the day of the Mission.
Home Phone - -
Work Phone - -
Preferred Contact Phone
Please Select if Applicable: Student
(Occupation and employment info required in order to comply with Federal campaign law)
* Occupation
Ex: Attorney; Homemaker
Self Employed
* Employer
Ex: Verizon
Mission Registration
* Registrant Type: Total Family Membership rate is $180.00. You can register as many family members as you like. For non-family members, please use a separate registration form.
Which Members of Congress do you have significant relationships with?
Please list them:
Type:
Last name:
State:
Affiliation:
(+) Add Member of Congress Connection
List former residence, family, or business ties outside the tri-state area (aids meeting placement):
I would like to be grouped with the following people if possible:
Please list:
Would you like to be a Group Leader? (Please note: Selecting this option will not automatically make you a group leader. For more information, please email us)
Do you have experience hosting or moderating Zoom meetings?
Synagogue, religious or community center affiliation (optional):
Support NORPAC

Your Membership fee covers a part of our over-all costs to run the Mission to Washington and our year-round efforts. If you would like to help support the success of the trip and other activities strengthening the US-Israel relationship, please choose an additional Membership category from the list.
Contributions to NORPAC are not tax deductible.
If your contribution exceeds $5,000/person per year, we will contact you to reallocate or refund any amount over the FEC-mandated limits.
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.

Additional Membership Categories (added to Membership Fee above):
$10,000 President's Minyan
$5,000 Presidential Cabinet
$2,500 Senatorial Cabinet
$1,800 Congressional Cabinet
$1,000 Consulting Cabinet
$500 Benefactor
$250 Patron
$100 Sponsor
Other Amount $
Not at this time.

*Please 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.

Please call 201-788-5133 for assistance if you have any issues with registration.