America’s Electric Cooperatives PAC – Application Form

America’s Electric Cooperatives PAC gives you, the member-owner, the opportunity to use your voice on behalf of your cooperative. State and federal government officials make policy decisions that affect your local cooperative and your way of life. This program is an easy way for you to help determine who gets elected to make those decisions.

Fill out the form below to enroll in the PAC and start making a difference in your co-op community.

"*" indicates required fields

First Name*

Last Name*

Email Address*

Phone Number

Member Number*

Address*

City*

State*

Zip Code*

Please add the following amount to my monthly bill:*

Regular Member: $2.08 per month ($25 per year)

Ambassador Club: $4.17 per month ($50 per year)

Century Club Member: $8.33 per month ($100 per year)

Vice President's Club: $20.83 per month ($250 per year)

President's Club Member: $41.66 per month ($500 per year)

Leadership Circle: $83.32 per month ($1,000 per year)

Other (Please call me for my donation amount)

Contributions to the America's Electric Cooperatives PAC® are not tax deductible for federal income tax purposes. Contributions to America's Electric Cooperatives PAC are voluntary and will be used for political purposes. You have the right to refuse to contribute without reprisal. Federal law prohibits contributions from foreign nationals who lack permanent resident status. Any contribution guidelines presented are merely suggestions. You are free to contribute more or less than the suggested amounts, or not at all. NRECA will not favor or disadvantage anyone by reason of the amount contributed or a decision not to contribute.

*Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and name of employer of individuals whose contributions exceed $200.

America's Electric Cooperatives PAC Application Form

Fill out the form below to enroll in the PAC and start making a difference in your co-op community.

About the PAC

Thanks to our Energy Partners: