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and mail this form to the address below to donate to the NYSALM State
PAC
NYSALM State PAC Contribution Form
Thank you for your support of the NYSALM State PAC! Your contribution
will help us in our continued struggle to maintain and establish
pro-midwife legislation in New York State.
Your contribution goes directly towards political action. Please
be generous!
New York State requires that both candidates and political committees
report contributions and expenditures. Individuals have no reporting
requirements. Political contributions are not tax deductible.
________________________________________
NYSALM State PAC
115 Payson Avenue
Apartment 1D
New York, New York 10034
All donations must be in check form and made payable to NYSALM
State PAC
| ___ $25 |
___ $50 |
___ $100 |
___ $200 |
$________other |
Name: ___________________________
Address: _________________________
_________________________________
Tel: _____________________________
Email: ___________________________
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