Filling out the below form is an automatic materials request. There is no approval process necessary.

This form should be filled out by the association executive, GAD or PAC director to ensure the highest possible level of accuracy.

Section I. Basic Information
Contact's Full Name
Title
Association Name
Address - Line 1
Address - Line 2
City
State	Please select AK AL AR AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK ON OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY
Zip code
Phone Number
Fax Number
Email Address
Website
Number of brochures requested (Minimum=100, Maximum=Membership Total)
Date materials are needed (Please note, we need at least 20 business days to comfortably meet your deadline. PLEASE MAKE SURE THERE IS AMPLE TIME TO MEET YOUR DEADLINE.)
Please explain, briefly, the specific use of the materials and how they will be distributed.
Section II. Financial Information
Please list the following information for all the years listed (list 100% of receipts, not just NAR's 30%).
2010
2010 Association Membership
2010 Number of Donors
2010 Participation Rate
2010 Total Hard Receipts	$
2010 Total Soft Receipts	$
2010 Overall Total Receipts	$
What is your RPAC state-assigned fundraising goal for 2011?	$
What goal was set by your state or local board?	$
How many members of NAR's Major Donor Recognition Program do you have?
President's Circle
Golden "R"
Crystal "R"
Sterling "R"
Section III. Design Your Brochure
Choose one of the following brochure designs. (You can click on a thumbnail image to view the brochure PDF.)
	Design 1: "You're Best Investment in Real Estate
	Design 2: "RPAC Is Your Resource" Version 1
	Design 3: "Business/Teamwork/Leadership"
	Design 4: "Join the Team"
	Design 5: "RPAC is Your Resource" Version 2
	Design 6: Dues Billing Insert - "Investment"
	Design 7: Dues Billing Insert - Resource V1
	Design 8: Dues Billing Insert - "Leadership"
	Design 9: Dues Billing Insert - "Join the Team"
	Design 10: Dues Billing Insert - "Deliver"
	Design 11: "Wave" Brochure
	Desgin 12: "Teamwork" Brochure
	Design 13: "Invest in America"
Address to print on brochures:
OPTIONAL: List the local issues you want to have on your brochures. (If you do not have your local issues, we will include national and state issues here.)
Agreement
By submitting this form, my association agrees that RPAC and federal issues content must be included as part of the marketing materials.
Yes, I agree.
Please review all areas of this document and make sure that all the information is correct. Then click the Submit button below.