Membership Pledge Form

Alliance for Accountability Members are the backbone of the movement against Islamophobia and anti-Muslim sentiment. With a minimum annual commitment of $1,200, members can aid our Hybrid PAC to keep Congress accountable. If you are interested in pledging to make a contribution, please fill out the following form.

Note: Contributions to the Alliance for Accountability are not tax deductible. Federal law requires us to use our best effort to collect and report the name, mailing address, occupation and name of employer of individuals whose contributions exceed $200 in a calendar year.

First name

Last name

Phone

I would like to be added to the A4A WhatsApp Group

Zip Code

Occupation

Annual Pledge Amount ($): $1,200 minimum annual contribution is required

I would like to make my pledge in the form of monthly donations equalling to at least $1,200 in one year (i.e. $100/month)

Host an Information Session

I am interested in hosting a private event in my home.

I am interested in hosting a private event at a venue (restaurant, office space, etc)

I am part of an organization that can host an event.

POLITICAL CONTRIBUTIONS: I confirm that the following statements are true and accurate: (a) I am not a foreign national who lacks permanent residence in the United States. (b) I am not a federal contractor. (c) This contribution will be made from my own funds, and not those of another. (d) This contribution will not be made from the general treasury funds of a corporation, labor organization, or national bank. (e) This contribution will be made on a personal credit card or debit card for which I have the legal obligation to pay and is not made either by a corporate or business entity card or on the card of another person. (f) I am at least 18 years old

PLEASE READ & ACCEPT OUR TERMS & CONDITIONS: Statements that explicitly threaten or extol violence against groups or individuals on the basis of national origin, race, or religion violate our policies and do not represent our values. Any such statements or behavior shall be grounds for the cancellation of membersip or contribution