The BIPAC Action Fund Enrollment Form

Please complete the form below. Mandatory fields marked *

Personal Information
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Home Address

Select the Raffle item you would like to donate towards winning:

$25 for a chance to Brew and Bottle Your Own Beer

$15 for a chance at a Luxurious Spa Package

$5 for a chance at a Golf Package at Hilltop Golf Club, Alexandria

(Please make a donation for the raffle as many times as you would like)


I would like to make an additional contribution of:


Please note:

  • Under Federal Law, the Action Fund can accept only voluntary personal contributions.
  • Contributions to the Action Fund are not tax deductible.
  • A legal maximum of $5000 may be given to the PAC in a calendar year.
  • Federal Law requires PACs to report the name, mailing address, occupation, and name of employer of each individual whose contributions exceed $200 in a calendar year.
  • The form is paid for by BIPAC and not authorized by any candidate or candidate's committee.
  • You must be a U.S. citizen or a green card holder with permanent resident status to participate. Contributions by foreign nationals are not permitted.

 
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