Posted on November 22, 2024 - April 30, 2025 by cguske AIA Virginia > Form > PAC Contribution Form AIA Virginia PAC Contribution "*" indicates required fields PhoneThis field is for validation purposes and should be left unchanged.Name* First Last AIA DesignationAIAAssociate AIAFAIAEmeritusNoneChapter*Blue RidgeCentral VirginiaCoastal VirginiaNorthern VirginiaRichmondnone or otherEmail* Enter Email Confirm Email Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer Name*Employer Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Would you like to publicly credited with our supporters?*YesNoWould you like to receive an AIA Virginia PAC lapel pin?YesNofor donations above $50.Is this a personal contribution or is it on behalf of your firm?PersonalCompanyDonation Amount* Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Security Code Cardholder Name PAC contribution declaration* I affirm and attest.In contributing to the AIA Virginia PAC, I affirm and attest to the following: I am a U.S. citizen or lawfully admitted permanent resident (i.e., green card holder). I am at least eighteen years of age. This contribution is made from my own funds or from the funds of an authorizing corporation or other entity, and the funds are not being provided by any other person or entity.
