PAC Application Form

Secured by Thawte Premium SSLThe ACSS Political Action Committee is the easiest way for you to support candidates and issues that will benefit your career, compensation, and benefits.

By donating as little as $2 a month, you can help ensure that the State is working for you, not against you.

Fill out our PAC Contribution Form now and join the fight for better careers!

Payroll Contribution: I authorize the following to be withheld from my monthly pay warrant for the ACSS PAC.

Disclosure Relating to ACSS Electronic Political Action Committee (PAC) Contribution and Agreement

This agreement contains the terms that govern your use of the ACSS Electronic PAC Contribution and Agreement. You agree to the terms of this Agreement by typing your full name in the box below and clicking on the Submit Form button.

By typing your full name in the box below and clicking the Submit Form button, you are agreeing to contribute the MONTHLY amount you selected above to the ACSS PAC and authorize ACSS to establish with your employer the withholding of the full amount of said contribution from your MONTHLY pay warrant.

I understand that this contribution is a voluntary, non-tax-deductible contribution.

This contribution authorization will remain in effect until either I or ACSS cancel it.

The State Controller's Office requires that you certify your PAC contribution by submitting an electronic signature.

By typing my full name in this box and clicking "Submit Form" I certify that the information provided is accurate and true. I agree to the terms and conditions above and hereby commit to donate to the Association of California State Supervisors' Political Action Committee.