WSRS PAC Donation Form

Contact Information

Name:

First

Last

Billing Address:

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Phone:

Area Code

Phone Number

E-mail:

State law requires that you report information about your employer:

Practice/Employer Name:

City:

State

PAC Donation Amount:

$75

$100

$150

PAC Donation Amount - Other:

Total:

Please type the characters seen below:

Upon completing the form and clicking "submit," you will be directed to PayPal to make the WSRS PAC payment. You do not have to have a PayPal account in order to make a payment.

Please note: Contributions to the WSRS PAC are not deductible as a charitable contribution for federal income tax purposes. In addition, no portion of any contributions to the WSRS PAC can be deducted as a business expense on your federal income tax returns.

INQUIRIES: Contact Debra Alderman, Executive Director, at the WSRS Office at 206-956-3650 or email debra@wsrs.org