Message form

                  You are an American citizen who has had problems with banking in the USA or abroad, 
                  or problems filing and paying your US taxes from abroad.

                  ACA and other action groups are gathering personal experience statements 
                  about these problems which will be submitted to key Members of Congress and top 
                  Government officials in Washington and possibly selected for insertion into the 
                  Congressional Record, news reports and/or other media accessible to the public. 
 
                  If you wish to share your personal experience concerning banking or taxes with ACA, 
                  please fill out and send this form.
                  Information that you provide here will only be used as per your instructions below.


       First Name:   (Required)
      Family Name:   (Required)
    Email address:   (Required)
      Resident of:  
            Phone: 
          Subject: 
          Message (Hint: you can cut and paste a prepared text but please do not use fancy formatting)
                   

          Privacy level, choose one: 
                1-Please use my personal story, but only in an anonymous manner.
                2-Please use my personal story, but include only my first name.
                3-Please use my personal story, including my complete name and geographical location. 
                4-Please use my personal story, and include all information provided, without 
                   limitation; in addition, I would be willing to consider providing writtten 
                   or oral testimony directly to any Congressional Committee holding hearings 
                   on this subject.                
                 Waiver and Indemnity.
                       I hereby instruct and authorize ACA to distribute all details of my Personal Statement 
                       to such news and governmental organizations as ACA may deem appropriate, within the 
                       limits of the stated privacy level I have indicated. I expressly waive all claims 
                       and rights I may have in relation to the confidential nature of the details in the 
                       Personal Statement, and agree to fully indemnify ACA against all liabilities, 
                       expenses and claims which may arise as a result of such distribution. 
                       Swiss law applies and the Canton of Geneva is the sole forum for the resolution 
                       of any disputes related to this authorization.

                    Type "I agree":   (Required)

                    Anti-spam test:
                    What is 14 minus 5 ?   (Required)

                   

If you have trouble sending this message via the internet, phone or fax our Geneva office: +41 22 3400233.
or send to: ACA,  5 rue Liotard,  1202 Geneva,  Switzerland.