Ohio ACEP PAC Contribution

All information below is required for PAC reporting, and must be accurate. PAC contributions must be made using personal funds. Ohio ACEP PAC is legally required to send contact information to the state for contributions made to the PAC.
Note: Contributions to Ohio ACEP PAC are not deductible as charitable contributions for income tax purposes.

Contact Information Required for PAC Reporting

First Name:
Last Name:
Credentials:
E-mail:
Home Address:
City: State: Zip:
Employer:
Primary Phone:
I understand that all information above is required for PAC reporting and must be accurate.
I verify that all the information entered above is accurate.
I understand that my contribution must be made using personal funds (not corporate or other PAC funds).
I verify that my contribution will be made using my personal funds.

Ohio ACEP PAC Contribution

Contribution Amount:
   - denotes required fields

Advancing Emergency Care