OOPAC Contribution

A Strong OOPAC! Protecting and Enhancing Optometry's Future in the Legislative Environment!

A target of $240 annually from each OOA member is needed to maintain a healthy OOPAC (only $20 per month or $.66 cents per day!)

Corporate contributions are prohibited. However, partnerships, LLCs and other unincorporated entities may contribute, but must provide the name or an owner to whom attribute the contribution. Ohio law requires that all contributors must provide their name and address regardless of the amount of the contribution and the name of their employer if the contribution is for more than $100. If the contributor is self employed, the business name and occupation of the contributor must be provided.

Basic Information

First Name
Middle Name
Last Name
Organization
Employer Name
Address
City State Zip
Phone Fax
Email

OOPAC Contribution

My OOPAC contribution is
If 'other', please specify amount $

Authorization

Please provide your name, initials and date for authorization of the above contribution.
Name
Initials Date ?
   - denotes required fields