PROTEC17 - PAC VERIFICATION

This form is to verify that donors to the PROTEC17 Political Action Committee (PAC) fund meet current federal guidelines for political contributors.

Name*
First Last
Home Email*
Phone Number*
Please certify the following statements are true by checking the box and signing the line that follows.
I am least 18 years old. I am a U.S. citizen or lawfully permitted resident (i.e., green card holder) I am making the contribution from my own funds, and funds are not being provided by another person or entity for the purpose of making this contribution. I am not a foreign national nor is this contribution financed in any part by a foreign national, and no foreign national was involved in making decisions regarding the contribution in any way. I am not a federal contractor I am not a registered Federal lobbyist I am not a registered foreign agent.*
Yes, I certify that the following statements are true and agree to these contribution rules. This certification shall apply to each contribution I make and remain in effect until revoked in writing via U.S. mail to PROTEC17.
I am least 18 years old.

I am a U.S. citizen or lawfully permitted resident (i.e., green card holder)

I am making the contribution from my own funds, and funds are not being provided by another person or entity for the purpose of making this contribution.

I am not a foreign national nor is this contribution financed in any part by a foreign national, and no foreign national was involved in making decisions regarding the contribution in any way.

I am not a federal contractor

I am not a registered Federal lobbyist

I am not a registered foreign agent.

Signature*

Date Signed*