ACRE Sign-Up

YES! I want to help keep the voice of rural electric cooperatives heard in the state and national political process by joining the Co-op Owners for Political Action®. Please add the following amount to my monthly electric bill.

Regular COPA member $2.08 per month ($25 per year)

Ambassador Level $4.17 per month ($50 per year)

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

*Vice President's Club $20.83 per month ($250 per year)

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

*Leadership Circle $83.32 per month ($1,000 per year)

First

Last

Account Number

Telephone Number

Email Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Only residential members are eligible to join. Contributions to ACRE are for political purposes. Contributions to ACRE through ACRE Co-op Owners for Political Action® are strictly voluntary. Contributions to federal and state Political Action committees are not deductible for tax purposes. You 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. Contributions may be stopped at any time upon notification to the cooperative.

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

Only residential members are eligible to join. Contributions to ACRE are for political purposes. Contributions to ACRE through ACRE Co-op
Owners for Political Action® are strictly voluntary. Contributions to federal and state Political Action committees are not deductible for tax
purposes. You 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. Contributions may be stopped at any time upon notification to the cooperative.

Signature

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

Employer Name

Occupation

Important Information