OPPAC Contribution Form

Yes, I want to support the Ohio Psychiatrists' Political Action Committee (OPPAC).

Per changes in the Ohio Revised Code, enacted by the Ohio General Assembly, political action committees in Ohio can no longer knowingly accept contributions from “foreign nationals.” The new provision of law defines a “foreign national” as anyone who is not a US Citizen or National.
Please note that by proceeding with this transaction, you certify that the contribution is from: (i) in the case of an individual, from a U.S. citizen or national, and (ii) in the case of a non-individual, an entity that is organized domestically and only has a domestic principal place of business; you also certify that for any of the contributions: (i) underlying individual sources are from U.S. citizens or nationals, and (ii) underlying entity sources are from entities organized domestically and only have a domestic principal place of business.

Please select Contribution Level

Level
Other Amount (minimum of $10)
All contributions must be personal - state law prohibits corporate contributions

Basic Information

First Name
Last Name
Email
Home Address
City State Zip
Home Phone
Employer*
*Employer information or official name of your business if self-employed is required by the Secretary of State if the contribution exceeds $100 (Pursuant to R.C. 3517.10(B)(4)(b)(ii)).
Check here if you do NOT wish for your contribution to be identified in membership information.
   - denotes required fields