To contribute to NORPAC you can fill out this form electronically to pay securely online or you can print out either of the two forms below, In both Word and Adobe Acrobat Formats, and mail it to the address indicated on the sheet.

It is against Federal Law for any PAC to accept Corporate Contributions.

NORPAC
PO Box 5595
Englewood, NJ 07631

Membership Form in Word Format

Membership Form in Adobe Acrobat Format

First Name(s)
Last Name
Address
City
State	-- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Zip Code
Telephone	- -
Fax	- -
email
Spouse's email
NORPAC will never distribute your email address to an outside organization
Occupation
Employer
Self Employed	Yes No

Please note that the maximum a couple can contribute per calendar year is $10,000,and $5,000 per individual
Membership Categories
	$10,000	President's Minyan
	$5,000	Presidential Cabinet
	$2,500	Senatorial Cabinet
	$1,800	Congressional Cabinet
	$1,000	Consulting Cabinet
	$500	Benefactor
	$250	Patron
	$100	Member
	Other	(fill in amount during processing)
Reason for Contribution:

*I confirm that the following statements are true and accurate:

I am not a foreign national who lacks permanent residence in the United States.
I am not a federal contractor.
This contribution is made from my own funds, and not those of another.
This contribution is not made from the general treasury funds of a corporation, labor organization, or national bank.
This contribution is made on a personal credit card or debit card for which I have the legal obligation to pay and is not made either by a corporate or business entity card or on the card of another person.
I am at least 18 years old.

Contributions to NORPAC are not tax deductible.
Federal law requires us to use our best effort to collect and report the name, mailing address, occupation and name of employer of individuals whose contributions exceed $200 in a calendar year. Thank you for your cooperation.