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Authorization Card

O&P PAC logo
  • Yes, I want to spread the word about the O&P PAC!
  • I authorize O&P PAC to share information with me and others associated with this company as designated by me below.
  • As required by federal law, my company has not authorized a federal PAC solicitation by another trade association during any calendar year in which this "authorization" is granted to O&P PAC.
  • Signing this card in no way obligates me or others indicated below to contribute.

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ASTERISKED (*) FIELDS ARE REQUIRED.

*Name
*E-Mail
Credentials
*Employer
*Address 1
Address 2
*City
*State
*Zip Code
*Phone
Fax

O&P PAC may communicate with:

Myself only - and then I will decide whether to share information with others about PAC efforts.
Myself and individuals on the following list of executive officers and employees who have policymaking, managerial, professional or supervisory responsibilities:


...for a list of people associated with this company who may be invited to contribute to AOPA PAC.
Company employees registered for AOPA meetings, but only during these events.

Authorized Signatures
Signing multiple dates eliminates the need to contact you for authorization approval in upcoming years.

I authorize approval for 2008

I authorize approval for 2009

I authorize approval for 2010

I authorize approval for 2011

I authorize approval for 2012

You Can Also Print this form and fax or mail it to: 
Daniel Gurley 
Manager of Legislative & Regulatory Affairs
American Orthotic & Prosthetic Association
330 John Carlyle Street, Suite 200
Alexandria, VA 22314
Fax: (571) 431-0899

Questions? 
Contact Daniel Gurley at (571) 431-0876, ext. 212 or e-mail: DGurley@AOPAnet.org

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