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CPA Political Action Committee (CPAPAC)

Please print this form out and mail together with your check made payable to New York State Society CPAPAC to:

NYS Society CPAPAC
3 Park Avenue, 18th Floor
New York, NY 10016

Yes, I want to strengthen our voice with the New York State Legislature.

New York State election law requires political action committees to report the name, mailing address, phone number, occupation and name of each individual whose contribution exceeds $99.

Note: Contributions are not reimbursable by employers if you are a member in industry, government, or a professional corporation.

Please provide the following information:
Name __________________________________________________
Address __________________________________________________
City __________________________________________________
State ______
Zip _________________
Employer __________________________________________________
Occupation __________________________________________________
Phone _________________
Fax __________________________________________________
E-Mail ____________________________________________


If you have questions, contact Dennis O'Leary at (212) 719-8418 or via e-mail at doleary@nysscpa.org.

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