Political Action Committee Pin and Ribbon Request Form

PAC Pin and Ribbon requests must be received 21 days prior to the date of the event to allow for processing and shipping.

Contact Name(Required)

First Last

Contact Email(Required)

Enter Email Confirm Email

Event Name(Required)

Anticipated Attendance(Required)

Event Start Date(Required)

If this request is for something other than an event, please enter the date before which you are requesting receipt of your order.

Number of Pins(Required)

If you are requesting no pins, please enter the number Zero.

Number of Ribbons(Required)

If you are requesting no ribbons, please enter the number Zero.

Shipping Address(Required)

Street Address Address Line 2 City State ZIP Code

Comments

ALL unused pins must be returned within 2 weeks of conclusion of Event. Please ship unused pins to ASCLS, 419 Essex Place, Carol Stream, IL 60188