PAC Contribution Form


First Name	Last Name
Title
Email
Company
Address

City	State Zip
Phone
Fax
Web Address

Voluntary PAC Contribution
Amount:
	PAC Fund
	PAC Issues Fund
	PAC Advocacy Fund

The CASA PAC is a voluntary political organization that contributes to candidates for state office who share our philosophy and vision of the future of medicine. Political law and the CASA PAC Committee determine how your contribution is allocated. Contributions to PACs are voluntary and not limited to the suggested amounts.


PAC Contribution Rules: Corporate/Company can contribute $9,100 per calendar year. If individual owns 50% or more of the contributing company, the individual’s personal contribution and the company’s contribution cannot total more than $9,100. PAC contributions can only be used for campaign contributions. These funds cannot be used to pay for lobbying efforts (TDG Strategies).

Contributions are not deductible for state or federal income tax purposes.

- denotes required fields