BIO PAC: Prior Approval Authorization

Federal law requires that you provide prior approval before BIO PAC can solicit contributions from you and/or your eligible employees.

I authorize BIO PAC to communicate with and solicit contributions from me and any designated management-level employees of my company listed below.  As required by federal law, my company has not authorized any other trade association PAC to solicit its employees during the calendar years designated and my company will not approve other such solicitations for any year in which prior approval is granted to BIO PAC.  I understand that participation in BIO PAC is voluntary; not contributing will in no way reflect adversely on any solicitee, and contributions may only be accepted from U.S. citizens or permanent residents of the United States.

Such approval is granted for the following calendar years (federal law requires a separate signature for each year; please sign for each year for which you wish to grant approval):

Please include each person’s full name and title/occupation.