Prior Authorization Online

PRIOR AUTHORIZATION ONLINE

Signing this form allows ALFAPAC to communicate with you and your colleagues concerning PAC activities and to accept those contributions.

Federal law requires members to sign this prior authorization form in order for the executive or administrative personnel of the member corporation to be solicited by ALFAPAC. This authorization can only be given by your company’s primary ALFA contact. The company may not approve a solicitation by any other trade association for these years.

To authorize ALFAPAC to solicit voluntary contributions from the executive and administrative personnel and stockholders of your company, please complete and submit the following form. Please check the box or boxes below for the years in which prior authorization will be given.

Required field(s) are indicated by an *.
* First Name
* Last Name
* Company
* Title
* Primary Contact Email
Phone (do not include dashes)
* Address
Address 2
* City
* State
* Zip
Please check the corresponding box if ALFAPAC is authorized to solicit voluntary contributions from the executive and administrative personnel and stockholders of my company for the following years. Checking this box does not obligate you to make any contribution to ALFAPAC. It allows ALFAPAC to inform you and your executives of upcoming activities.
2012 Permission is granted
ALFAPAC is authorized to solicit voluntary contributions from the executive and administrative personnel and stockholders of my company for 2012. Please check if permission is granted. Checking this box does not obligate you to make any contribution to ALFAPAC, it allows ALFAPAC to inform you and your executives of upcoming activities.
2013 Permission is granted
ALFAPAC is authorized to solicit voluntary contributions from the executive and administrative personnel and stockholders of my company for 2013. Please check if permission is granted. Checking this box does not obligate you to make any contribution to ALFAPAC, it allows ALFAPAC to inform you and your executives of upcoming activities.
2014 Permission is granted
ALFAPAC is authorized to solicit voluntary contributions from the executive and administrative personnel and stockholders of my company for 2014. Please check if permission is granted. Checking this box does not obligate you to make any contribution to ALFAPAC, it allows ALFAPAC to inform you and your executives of upcoming activities.
* Primary Contact Certification
I certify that I am the primary contact for the above company/organization and that I have permission to grant the authorizations listed above.