MSHO PAC Donation Form

The Michigan Society of Hematology and Oncology and its members recognize that political action is essential in promoting and protecting the medical profession. Consequently, providing necessary funds to MHSO PAC must be a priority.

Contributor Information

First Name
Last Name
Credentials

Address
City
State
Zip

Employer
Occupation
Principal Place of Business Address
Address
City
State
Zip
Phone
Fax
Email

Spouse Contributor Information (if contributing jointly)

First Name
Last Name
Credentials

Address
City
State
Zip

Employer
Occupation
Principal Place of Business Address
Address
City
State
Zip
Phone
Fax
Email

Donation Amount

Amount
Other Amount $
Contributions to MSHO PAC are voluntary and used for political purposes. The amounts indicated are only a suggestion and you may give more or less or refuse to contribute without affecting your membership rights. Contributions to MSHO PAC are not deductible as charitable contributions for federal income tax purposes.
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