PAC Donation Form

Contact Information

First Name
Last Name
Organization
Title
Home Address
Address
City
State
Zip
Email
Phone

PAC Donation Amount

Please select the amount you wish to donate from the list below:
 
If you selected Other, please provide your donation amount below:
 $
All contributions are completely voluntary. You may refuse to contribute without reprisal. Any proposed contribution amounts are merely suggestions; you may choose to contribute more or less or not at all. Ohio Association of Area Agencies on Aging PAC will not favor or disadvantage anyone by reason of the amount contributed or the decision not to contribute. All materials prepared and paid for by Ohio Association of Area Agencies on Aging PAC.
   - denotes required fields