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MINEPAC – COALPAC Authorization Form

  • I approve the solicitation of financial contributions for MINEPAC or COALPAC political action committees for myself for the calendar year(s) listed below. This authorization may be rescinded at any time. I understand that, in any calendar year, your authorization may be given to only the PAC (or PACs) connected with one national trade association. Please check the boxes below for the year(s) you would like to authorize.
  • I approve the solicitation of financial contributions for MINEPAC or COALPAC political action committees for myself and designated employees, listed below, for the calendar year(s) listed below. This authorization may be rescinded at any time. I understand that, in any calendar year, your authorization may be given to only the PAC (or PACs) connected with one national trade association. Please check the boxes below for the year(s) you would like to authorize.
  • I approve the solicitation of financial contributions for MINEPAC or COALPAC political action committees for myself and all eligible employees at my company for the calendar year(s) listed below. This authorization may be rescinded at any time. I understand that, in any calendar year, your authorization may be given to only the PAC (or PACs) connected with one national trade association. Please check the boxes below for the year(s) you would like to authorize.
  • MM slash DD slash YYYY
  • Please type your full name to signify your digital signature confirming you have read the above information and agree to allow MINEPAC or COALPAC to contact you.

  • MINEPAC/COALPAC
    National Mining Association
    101 Constitution Avenue, N.W. Suite 500 East
    Washington, D.C. 20001
    wmacpherson@nma.org
  • Federal law requires us to use our best efforts to report the name, mailing address, occupation and name of employer of individuals whose contributions exceed $200 in a calendar year. Corporate contributions are prohibited by federal law. Contributions to COALPAC and/or MINEPAC are for political purposes. Only U.S. citizens and permanent residents can contribute to federal PACs. Participation is strictly voluntary. You may refuse to contribute without reprisal. Contributions to COALPAC and/or MINEPAC are not deductible as charitable contributions for federal income tax purposes.
  • This field is for validation purposes and should be left unchanged.

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