PACK Act Coalition Registration

Thank you for your interest in advocating for the enactment of the Packaging and Claims Knowledge Act, H.R. 6832 (PACK Act). Please review the advocacy letter calling for enactment of the PACK Act that is posted at AMERIPEN.org/Pack-Act. If you would like to join the Coalition meetings or add your organization to the list of supporters, please complete this form.

Fields marked with an * are required.

Contact Information

First Name *

Last Name *

Email *

Organization *

Organization Information

Question 1 *

Name & email address of any alternative participants from your organization.
If none of the above apply, please input "N/A" in the field below.

Question 2 *

I am employed and authorized by my organization to complete this form.

Question 3 *

My organization... (Select one below)

Supports the PACK Act and agrees to sign on to the Coalition letter and post our logo on the AMERIPEN PACK Act web page.

Supports the PACK Act but does NOT agree to sign on to the Coalition letter or post our logo on the AMERIPEN PACK Act web page.

Does NOT support the PACK Act.

Is undetermined on whether to support the PACK Act.

Question 4 *

If your organization does not support the PACK Act, or is undetermined, or does not want to sign the Coalition letter/provide its logo even though it supports the PACK Act, please explain the factors for your organization's position.
If none of the above apply, please input "N/A" in the field below.

Question 5 *

Does your company/organization have Federal lobbying and/or government affairs professionals that are willing to help AMERIPEN get the PACK Act enacted this year?

Yes

Maybe

Question 6 *

I am a third-party consultant or individual representing the interests of another party that wants to join the PACK Act Coalition.

Yes

Third Party Acknowledgement
If you answered YES to the previous question (#6), please read and complete the following section.

Question 7 *

What is the name of the Consultant and Consultant's firm?
If none of the above apply, please input "N/A" in the field below.

Question 8 *

What is the name of the Client who is requesting Consultant represent it at PACK Act Coalition meetings?
If none of the above apply, please input "N/A" in the field below.

Question 9 *

Consultant is permitted to participate in Coalition meetings and discussions on behalf of Client subject to the following conditions to which Consultant hereby expressly agrees with Client's consent: 1) Consultant may only participate on behalf of the Client and will not share any information gained from the Coalition with other clients; 2) Consultant will protect any information that the Coalition may share or is otherwise gleaned from Coalition activities as confidential, proprietary, and non-public; 3) Consultant will identify any possible conflicts of interest with existing clients and refrain from engaging with future clients that present a conflict of interest; 4) Client agrees to require Consultant to maintain a non-disclosure agreement with the Client that protects the confidentiality of the Coalition activities.

Yes

N/A

Please verify that you have checked the “I'm not a robot” checkbox.