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 |
____________________________________________ |