Virginia Orthopaedic Society

The premier voice for musculoskeletal health care in the Commonwealth of Virginia

ORTHO PAC Contribution Form

Donate to OrthoPAC

Help VOS join Legislators at the decision-making table.

OrthoPAC is your profession's voice in the political process. Contributing to the PAC is investing in your profession, patients, and high-quality health care from orthopaedic surgeons. A robust PAC helps ensure that policymakers understand that orthopaedic surgeons are leaders and experts in the field of orthopaedics, and that you are committed to helping your patients not only through providing care but also being strong advocates for sound policy.

OrthoPAC is a critical tool in our advocacy program. It allows us to support legislators who are friendly to our profession and issues in the General Assembly. Every year the legislature considers bills that could potentially impact our profession and patients. A strong PAC provides us the opportunity for our voice to be heard by elected officials in the legislature and executive branch. Our PAC enables us to support legislators who support our profession. Our goal is to keep Delegates and Senators who are friendly to our issues in the legislature.

Federal and State law require ORTHO PAC to collect and report the name, mailing address, and name of employer of individuals whose donations exceed $100 in an election cycle. Contributions are not tax deductible. All funds raised by ORTHO PAC are used in Virginia.

 

CONTRIBUTOR
   
First Name: 
Last Name: 
Degree: 
MD PhD
Other (specify)
   
CONTACT INFORMATION
   
Mailing Address: 
City: 
State: 
Zip: 
Email Address: 
   
Required by State Election Law:
Employer or Business: 
Principal Place of Business (city/county): 
   
CONTRIBUTION
 

$500.00 (Leadership Circle)
$250.00 (Advocate)
Other: $

   
PAYMENT TYPE

 

One-time payment
Monthly recurring payment (starting 8/2019 and ending 12/2019)
If you select this option the full contribution amount selected above will be applied each month
   
   
PAYMENT OPTIONS
   
Credit Card Type: 
VISA MasterCard AMEX
Card Number: 
Security code: 
For VISA or MasterCard it is on the back of your card in the signature box. The 3-digit code is printed on the right-hand side of your 16-digit credit card number.
For American Express the code is the 4-digit number printed on the front of your card either on the right-hand side directly above the credit card number or the left-hand side directly above the credit card number.
Expiration Date: 
Card Holder Name: