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Join us!
Print this form, fill out and mail along with
your check or credit card information to:
Patsy T. Mink PAC
P.O. Box 25002
Honolulu, Hawaii 96825
Supporters:
___ Founders Circle $1,000 ___ Sustainers Circle $750 ___ Leaders Circle $500
___ Friends $250 ___ Member $100 ___ Supporter $ _______
Make checks payable to: Patsy T. Mink PAC or use our PAYPAL link on our HOME PAGE to charge your credit card.
Mr./Mrs./Ms./Miss/______ (circle one)
Name: ___________________________________________________
Address (required): __________________________________________
Phone*(required):________________ Birthdate: ____(month) ____(day)
Fax*: ____________________E-mail*: _________________________
Occupation(required):________________________________________
Employer(required): _________________________________________
May we list your name on our press releases, brochures, other publications? Yes __No__
*please! no government phone numbers, faxes, or e-mail addresses
The Patsy T. Mink PAC is NOT A FEDERAL PAC,
it provides money to STATE candidates only.
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