ACRE Participation Form

Yes! I want to help keep the voice of rural electric cooperatives heard in the political process by participating in ACRE Co-op Owners for Political Action. Please add the following amount to my monthly electric bill:

Contributions to ACRE/ACRE Co-op Owners for Political Action are strictly voluntary. Contributions to federal and state Political Action Committees are not deductible for tax purposes. Consumer-owners have the right to refuse to contribute without reprisal. The contribution guidelines are suggestions only. You may contribute more or less than the recommended amount.

Please add the following amount to my monthly electric bill:

Regular Member ($2.08 per month/$25 per year)

Century Club Member ($8.33 per month/$100 per year)

President's Club Member ($41.66 per month/$500 per year)

Contributions may be stopped at any time upon notification to the cooperative.

I would like to make a one-time contribution in the following amount:

$25 Regular Member

$100 Century Club Member

$500 President's Club Member

Make check payable to ACRE COPA.

Lapel Pin Option:

I would like a complimentary ACRE Co-op Owners for Political Action lapel pin.

REMC Member Name: *

I affirm that my contribution has been made with non-corporate funds.

Address

City, State, Zip

Cooperative:

Email:

*Federal election Law requires the following information for contributions exceeding $200:

Employer:

Occupation:

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ACRE Participation Form