FitPAC - Solicitation Authorization Form
Will you please join our team? 

I understand that federal law requires Health & Fitness Association to obtain written permission before soliciting contributions to Health & Fitness Association, Inc FitPAC ("FitPAC"). 

I understand that my company can only allow one trade association political action committee to solicit me or eligible employees of my organization in any calendar year. 

As a qualified representative of a Health & Fitness Association member company, I authorize FitPAC to communicate with the individual(s) listed below from our company in addition to myself during the calendar years designated below for activities, events, and recruitment opportunities related to FitPAC. 

I understand this permission may be withdrawn at any time. 
Sign in to Google to save your progress. Learn more
Email *
Name  *
Title/Position *
Company *
Mailing Address *
City, State *
Zip *
Phone *
Email *
Names of specific employees, Departments, and Subdivisions we are authorized to contact. 
If blank, all eligible employees may be contacted. 
 *
This authorization shall apply for the following years (please check all that apply) *
Required
By checking the boxes below, I confirm the following: *
Required
Please sign this solicitation authorization form by typing your full name below *
This form is sent to you by Health & Fitness Association, Inc. FitPAC 
70 Fargo Street
Boston, MA 02210
Treasurer: Tom Richards
Contact: trichards@healthandfitness.org
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Tom Richards, LLC.

Does this form look suspicious? Report

Google Forms