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 per year. The Federal Elections Commission allows $5,000 total donation amount per year, per donor, per PAC.

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Donor Information
First Name *
Last Name *
Address *
Address 2
City *
State *	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code *
Occupation *
Employer *
Telephone *	Home Work
Email Address *
	Check this box if your address is the same as the credit card billing address. If it is not, please provide your credit card billing address below.
Address *
Address2
City *
State *	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code *
Credit Card Information
Donation Amount *	$5000    $3000 $1000 $500 $250 Other Donation Amount:
Card Type *	Visa Master Card American Express
Card Number *
Expiration Date *	1 2 3 4 5 6 7 8 9 10 11 12    2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
I Agree to the terms and conditions below:
Contributions must be made with personal funds and may not be reimbursed or otherwise paid by any other person or entity and contributors must be at least 16 years old. Contributions to the ALC PAC are subject to the prohibitions and limitations of the Federal Election Campaign Act. Contributions from corporations, labor unions, and federal government contractors are prohibited. Only U.S. citizens and foreign nationals who are lawfully admitted for permanent residence in the U.S. (i.e., a person with a valid "green card") may contribute to ALC PAC.

Arab American Leadership Council PAC
1600 K St. NW, Suite 601
Washington, DC 20006

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Paid for by the Arab American Leadership Council PAC, and not authorized
by any candidate or candidate’s committee.