OPAC- Orthopaedic Political Action Committee

DONATE TO OPAC/REGENCY CLUB

SUGGESTED DONATION LEVELS:

Supporter Level: Up to $100 Annually
Regency Level: $600 Annually ($50.00 Monthly)

Contact Information

First Name *

Middle

Last Name *

Designation

Office Street Address (No P.O. Box please) *

City *

State

Zip Code

Country:

E-Mail: *

Phone Number *

Contribution Amount:

If you would like to set up re-occurring monthly contribution, call the COA office to set-up - 916-454-9884.

OPAC money is used to support California elected officials who serve on key legislative committees and have supported COA's viewpoints on legislation. You are not limited to the suggested contribution nor are you required to contribute to OPAC.

PLEASE NOTE: Payments/Contributions to COA are not tax deductible as charitable contributions for federal income tax purposes. Due to federal laws limiting the tax deduction of membership dues paid to organizations involved in lobbying activities, 17% of your dues payment to COA may not be deducted as a business expense.

Since YOU are Interested in POLITICS...

COA encourages YOU to get personally involved in politics. Be part of the discussion, join COA’s Key Contact Program.

I want to get to know my local elected officials.

Yes

No

I am involved at a local level. I know/have met the following local legislators:

	Please fill in name.
State Assembly Member	Please fill in name.
State Senator	Please fill in name.
Member of Congress	Please fill in name.
Other Local Official	Please fill in name.

Payment Information

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