CONTRIBUTION FORM

Donate online at www.freecongress.org

Name: _______________________________________________________

Address: _____________________________________________________

City: ________________________ State: ______ Zip:_____________

Work Phone: ________________ Home Phone: ________________ Fax: ________________ Email: _________________

Principal Occupation/Job Title: __________________________ Full Name of Employer: ___________________________

Please charge my gift to: _____Visa _____MasterCard _____Amex _____Discover

Account Number: ____________________________ Expiration Date: ___________ V Code: ___________
Name on Card: ________________________________________________
Please charge a one-time gift in the amount of $___________________ to ______________________________ (identify
the organization you wish to donate to: Free Congress Foundation, Inc. – 501(c)(3) or Free Congress Action,
Inc. – 501(c)(4))

I WOULD LIKE TO MAKE THE FOLLOWING CONTRIBUTION TO SUPPORT

FREE CONGRESS FOUNDATION, INC. - 501(c)(3)

$2,500  $5,000 $10,000 $25,000 Other $______

Please make your check payable to Free Congress Foundation - 501c3

Please send your contribution to: Free Congress Foundation - 501c3

Attn: Annaghia Oliver
1423 Powhatan Street #2
Alexandria, VA 22314
Or fax it to 703-837-0031

Contributions to the Free Congress Foundation, Inc. are tax deductible to the limits provided by law. Free Congress
Foundation is a non-profit, non-partisan 501(c)(3) educational organization that conducts research on public policy solutions
and educates the public about public policy. No goods or services were provided in exchange for your gift.

I WOULD LIKE TO MAKE THE FOLLOWING CONTRIBUTION TO SUPPORT

FREE CONGRESS ACTION, INC. – 501(c)(4)

$2,500  $5,000 $10,000 $25,000 Other $_____

Please make your check payable to Free Congress Action, Inc. – 501c4

Please send your contribution to: Free Congress Action, Inc. - 501c4
Attn: Annaghia Oliver
1423 Powhatan Street, #2
Alexandria, VA 22314
Or fax it to 703-837-0031
Contributions to Free Congress Action, Inc. are not tax deductible. Free Congress Action is a non-
profit, non-partisan 501(c)(4) organization that advocates new and positive conservative solutions to some of the biggest
changes facing America. Founded in 2010, Free Congress Action focuses special attention on ways to reduce government
spending, encourage economic growth and job creation, and modernize entitlement programs. Free Congress Action also
addresses homeland security issues, national transportation policy, and challenges facing America's families and our
traditional values.
CALIFORNIA: Free Congress Foundation’s financial statement and Free Congress Action’s current
financial information are available upon request to Free Congress Foundation, 1423 Powhatan Street #2,
Alexandria, VA 22314. COLORADO: Colorado residents may obtain copies of registration and financial
documents from the office of the Secretary of State, 1-303-894-2680, http://www.sos.state.co.us, re
Registration No.20103021780. FLORIDA: A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL
INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING
TOLL- FREE, WITHIN THE STATE, 1-800-435-7352, re Florida Registration No. ___________. GEORGIA:
A full and fair description of the programs and activities of Free Congress Foundation and Free Congress
Action and each financial statement is available upon request at the address indicated above. KANSAS:
The annual financial report for Free Congress Foundation and Free Congress Action, 1423 Powhatan Street
#2, Alexandria, VA 22314, State Registration No. ___________, is filed with the Secretary of State.
MARYLAND: A copy of the Free Congress Foundation and Free Congress Action financial reports are
available by calling Free Congress Foundation/Free Congress Action at 1-703-837-0030 or writing to us at
1423 Powhatan Street #2, Alexandria, VA 22314. For the cost of copying and postage, documents and
information filed under the Maryland charitable organizations law can be obtained from the Secretary of
State, Charitable Division, State House, Annapolis, MD 21401, 1-410-974-5534. MICHIGAN: License
Number MICS ___________. MINNESOTA: Free Congress Foundation and Free Congress Action are
located at 1423 Powhatan Street #2, Alexandria, VA 22314. Contributions to Free Congress Foundation, a
501(c)(3) research and educational organization, are tax deductible. Contributions to Free Congress Action,
a 501(c)(4) policy advocacy organization, are not tax deductible. MISSISSIPPI: The official registration and
financial information for Free Congress Foundation and Free Congress Action may be obtained from the
Mississippi Secretary of State’s office by calling 1-888-236-6167. NEW JERSEY: INFORMATION FILED
WITH THE ATTORNEY GENERAL CONCERNING THIS CHARITABLE SOLICITATION MAY BE
OBTAINED FROM THE ATTORNEY GENERAL OF THE STATE OF NEW JERSEY BY CALLING 1-973-
504-6215 AND IS AVAILABLE ON THE INTERNET AT www.njconsumeraffairs.gov/ocp.htm#charity. NEW
YORK: Upon request, a copy of the latest annual report can be obtained from this organization or in
writing from the Office of the Attorney General, Dept. of Law, Charities Bureau, 120 Broadway, New
York, NY 10721. NORTH CAROLINA: Financial Information about Free Congress Foundation and Free
Congress Action and a copy of each organization’s License are available from the State Solicitation
Licensing Branch at 1-888-830-4989. PENNSYLVANIA: Our official registration and financial information
may be obtained from the Pennsylvania Dept. of State by calling 1-800-732-0999. VIRGINIA: A financial
statement for the most recent fiscal year is available upon request from the State Division of Consumer
Affairs, PO Box 1163, Richmond, VA 23218. WASHINGTON: The notice of solicitation required by the
Charitable Solicitation Act is on file with the Secretary of State’s office. Financial Disclosure information may
be obtained by calling the Office of the Secretary of State at 1-800-332-4483. WEST VIRGINIA: West
Virginia residents may obtain a summary of the registration and financial documents from the Secretary of
State, State Capital, Charleston, WV 25305. IMPORTANT NOTICE: REGISTRATION OR LICENSING
WITH ANY OF THESE STATES DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR
RECOMMENDATION BY THE STATE.