NADPac Brochure

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YES! I would like to help NADPac support Members of Congress who understand the dental benefits industry and share an interest in improving consumer access to affordable, quality dental care.

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Voluntary Contribution Amount: Please select your contribution amount in one-time, monthly or quarterly installments:

r $2,500 President’s Group (one-time payment)

r or $208.33/month

r or $625/quarter r $1,000 Leadership Team (one-time payment)

r or $83.33/month

r or $250/quarter

...a united voice in shaping the future of the dental benefits industry...

r $500 Capitol Club (one-time payment)

r or $41.66/month

r or $125/quarter r Sustaining Member: _______ (one-time payment)

r or $ ____ per month

r or $ ____ per quarter

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Enclose a personal check payable to NADPac or complete the Payment Information section of this form for credit card contributions. All contributors must complete the Donor Information section on the opposite side of this form.

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NADPac Contribution Form

Political Action

Committee National Association

12700 Park Central Drive, Ste 400 Dallas, Texas 75251• nadp.org 972.458.6998 • info@nadp.org

of Dental Plans

Please return the completed contribution form to NADPac at 12700 Park Central Drive, Suite 400, Dallas, TX 75251-1529. Payment information for credit card contributions may also be submitted via phone at (972) 458-6998.

Note: Contribution amounts contained here are merely suggestions. Sustaining members whose monthly or quarterly contributions equal the President’s, Leadership or Capitol levels annually will be recognized at those levels.

Political Action Committee

What is NADPac?

The National Association of Dental Plans Political Action Committee (NADPac) is a bipartisan political action committee established by the National Association of Dental Plans. NADPac collects voluntary contributions from NADP members and contributes the funds in support of candidates for federal office. By law, NADP cannot itself contribute to candidates. Only through the PAC can funds be disbursed to federal candidates.

Donor Information NADPac Contribution Form

name: __________________________________________ email: __________________________________________ home address: __________________________________ address line 2: ___________________________________

Why Support NADPac?

NADP and the dental benefits industry are faced with an increasing barrage of state and federal legislative and regulatory issues. Decisions on these issues are made by policy makers that must run for office almost continually. NADPac contributions support federal candidates for public office who understand the dental benefits industry and share our interest in improving consumer access to affordable, quality dental care. Other interest groups such as the American Dental Association contribute over $1 million to federal candidates. In order to be increasingly effective, NADPac must be able to contribute to campaigns throughout the year and not just during an election cycle.

Who can contribute?

Individuals and non-corporate members of NADP may voluntarily contribute personal funds, as well as the leadership and staff of those NADP member companies that have granted NADPac approval to contact their employees. NADP funds the operating expenses of the NADPac so 100% of your contributions go to candidates.

Who receives NADPac contributions?

NADPac is a non-partisan committee that disburses funds based on a variety of factors as outlined by the NADPac Guidelines. Contributions are only made to federal candidates and are overseen by the NADPac Committee, which meets several times a year. The Committee is appointed by the NADP Board to be representative of NADP membership.

How do I support NADPac?

Simply fill out this form and include your personal check or credit card information. If you have any additional questions about joining NADPac, please contact (972) 458-6998.

city: ____________________________________________ state: _________ zip code: ________________________ employer: ______________________________________ job title: ________________________________________ To be completed for check & credit card contributions

Payment Information card #: _________-________-________-________ name: ____________________________________

as it appears on card

expiration: _________/__________ billing zip code: _______________ card type: q amex q visa

q mastercard

q discover

CSC #: _____________ Authorized signature: __________________________________________ Please return the completed contribution form to: NADPac 12700 Park Central Drive, Suite 400 Dallas, TX 75251-1529.

Payment information for credit card contributions may also be submitted via phone at (972) 458-6998.

NADPac is a separate, segregated fund established by NADP. Voluntary contributions by individuals to NADPac must come from personal checks or credit cards although voluntary contributions from registered political action committees (PACs) are acceptable. All NADP members and their employees have a right to refuse to contribute without reprisal.

Contributions to NADPac will not benefit or disadvantage NADP members or their employees.

Donations to NADPac are not tax deductible as a charitable contribution. Federal law requires NADPac to use best efforts to collect and report the name, mailing address, occupation and name of employer of individuals whose contributions exceed $200 per calendar year. Some state laws require the collection and reporting of this same information on contributions for $10 and above.