IBWA Authorization to Solicit Form

On behalf of my company, I hereby authorize the International Bottled Water Association PAC to solicit voluntary, personal contributions from my company’s executives, administrative personnel, and stockholders (the “restricted class”) during the calendar years indicated below. I understand that the International Bottled Water Association PAC will not contact any of my company’s employees without coordination with me and my prior approval. I certify that my company is a current member of the International Bottled Water Association and understand that for the years indicated, my company cannot authorize any other trade association PAC to solicit contributions from its “restricted class”. Further, I understand that this approval to solicit does not in any way obligate me, my company’s employees, or my company’s stockholders to contribute to the International Bottled Water Association PAC.

About You:
First Name
Last Name
Company
Company Address
Company City, State, Zip
Email Address
Phone Number
PIN
Create and enter any four to ten digit or character code. This PIN will be used when you confirm your prior approval submission.
Your Approval:
Choose all that apply...
Yes, I confirm that my company has not given authorization to any other trade association this calendar year.
Yes, my company authorizes the PAC to solicit me for contributions to PAC.
   My company gives PAC authorization to solicit the employees on the list I'll send to you.
or Please send me information on how to
solicit my employees on behalf of PAC.
Valid Year(s):
Select the year(s) you want this authorization to be in effect.
2017
2018
2019
2020
This authorization can be revoked at any time by emailing cmartin@bottledwater.org. Contributions to the IBWA PAC will be used for political purposes. Only U.S. citizens or permanent residents can contribute to federal PACs.

International Bottled Water Association
1700 Diagonal Road
Suite 650
Alexandria, VA 22314
703.683.5213
Information Hotline: 1-800-WATER-11
info@bottledwater.org

Copyright © 2015. All Rights Reserved. International Bottled Water Association.