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Donations - Secure Online Donation Form

If you would like to set up a recurring donation, please select the option "Other" from the donation amount dropdown menu below, then enter the amount you wish to donate monthly in the textbox that appears.

Your annual giving amount will be aggregated and reported into the appropriate tier. Thank you!

Campaign/Fund Information
Campaign/Fund * Arizona Medical Association Political Action Committee This Site Secured By SSL Encryption
Donation Information
Donation Amount *

Payment Method * Credit Card
Donation Type *

Individual Verification *
I am submitting a personal ArMPAC contribution on behalf of myself and/or my spouse and/or family members.
Donor Comments
Donor Information
First Name *
Middle Name
Last Name *
Suffix
Organization
Email *
Address *
Address Cont.
City/Town *
Country *
State
Postal Code*
Phone *
Billing Information
[ Click here if billing address is the same as donor address ]
 *  
Organization 
Address *
Address Cont.
City/Town *
Country *
State
Postal Code*
Billing Phone *