1. WIFamMedPAC Contribution Form

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  8. *Required Field
    A valid email address must be provided.
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  10. The PAC will allow the Academy to be more nimble and ultimately more effective when participating in the political process. It will collect member contributions into a single account and distribute them to candidates under the direction of a governing board comprised of WAFP leadership.
  11. Amount of your contribution today
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  12. Government reporting standards require that we collect your employer information for all donations of $100 and more. If you are donating $100 or more please provide your employer information below.
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  18. Your total due
    $0.00 USD
  19. If you'd like to submit your payment online, after you click "Submit Your Contribution" below, you will be directed to WAFP's PayPal payment portal to complete your transaction. This page will give you the option to login and pay with your PayPal account if you have one, or "Pay with a Debit or Credit Card". * A PayPal account is NOT required. *
  20. Please select your payment choice
  21. If you'd like to contribute by check, please send your check to:

    WIFamMedPAC

    210 Green Bay Road

    Thiensville, WI 53092

Wisconsin Academy of Family Physicians  |  210 Green Bay Road  |  Thiensville, WI 53092
Phone: (262) 512-0606  |  Fax: (262) 242-1862

© 2014 Wisconsin Academy of Family Physicians

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