BikesPAC

• I authorize participation by my company in BikesPAC on the following basis. Please check the option that you approve: *
• I authorize BikesPAC to solicit all of our executive and administrative employees (I will provide names and home addresses of these employees for solicitation purposes). I authorize BikesPAC to solicit our executive and administrative employees, but prefer to designate someone from our company to collect and forward the contributions to BikesPAC rather than provide home addresses for solicitations. I also authorize BikesPAC to invite our executive and administrative employees to BikesPAC fundraising events. I will contribute directly to BikesPAC and prefer that you do not solicit any other eligible employees.

• First Name *
• Last Name *
• Title *
• Corporation *
• Email *

Authorizations

• Signature 1

• Authorize * I hereby authorize participation for 2010
• Signature*
  type your full name here to indicate your authorization
• Date: 02-11-2012

More Signatures

• Signature 2

• Authorize I hereby authorize participation for 2011
• Signature
  type your full name here to indicate your authorization
• Date: 02-11-2012

• Signature 3

• Authorize I hereby authorize participation for 2012
• Signature
  type your full name here to indicate your authorization
• Date: 02-11-2012

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