Prior Authorization MDMA PAC

Medical Device Manufactures Association Political Action Committee

In order to participate in MDMA PAC, we must first receive prior authorization from a member company under Federal Election Commission regulations. Signing this form enables MDMA PAC to communicate with you concerning PAC activities and to accept a contribution. Authorizations may also be mailed to: MDMA PAC, PO Box 34591, Washington, DC 20043.

Federal law requires members to sign this prior authorization form in order for the executive or administrative personnel of the member corporation to be solicited by MDMA PAC.
The company may not approve a solicitation by any other trade association for these years.

Name: *

Company: *

Title: *

Address: *

City: *

State: *

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Email: *

Authorization: *

2012 - By checking this box you are authorizing MDMA PAC to solicit voluntary contributions from you and or the executive and administrative personnel of your company for 2012.

2013 - By checking this box you are authorizing MDMA PAC to solicit voluntary contributions from you and or the executive and administrative personnel of your company for 2013.

2014 - By checking this box you are authorizing MDMA PAC to solicit voluntary contributions from you and or the executive and administrative personnel of your company for 2014.

2015 - By checking this box you are authorizing MDMA PAC to solicit voluntary contributions from you and or the executive and administrative personnel of your company for 2015.

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Prior Authorization MDMA PAC

Medical Device Manufactures Association Political Action Committee