Maine Oesteopathic Association MOPAC Contribution Form

	* - Indicates a required field
Contributor Information
*	Name:
*	Address:
*	City:
*	State:
*	Zip:
	Some members like to give contributions once a year. Some even like to do it more frequently. Donate to MOPAC by monthly Credit card payments until you say "STOP". This makes your political Contribution painless.
*	Amount:	$500 $250 $100 $75 $50 $25 $10 Other
*MOPAC contributions are not deductible on federal tax and may not be made by a corporation. All contributions will be reported to the Maine Ethics Commission in accordance with state law.*