FAMPAC Contribution



Please complete the following information as required by law for political contributions.

Voluntary contributions to FAMPAC ar not limited to the suggested amounts and should be written on a PERSONAL CHECK OR CREDIT CARD. Funds from corporations cannot be used for contributions and expenditures in either federal or state elections. If you are a Professional Association (PA) physician and send your contribution on a PA check, such funds must be from a non-refundable drawing account established to permit draws against salary or profits and represent personal funds rather than funds of your PA. The NCAFP will not favor or disadvantage anyone based upon the amounts of, or failure to, make PAC contributions. Copies of FAMPAC reports are filed with the Federal Election Commission and are available for purchase from the Federal Election Commission in Washington, D.C. Voluntary political contributions are subject to the limitations of FEC regulations, Section 110.1, 110.2, and 110.5 (Federal regulations require this notice). Contributions to FAMPAC are not deductible as charitable contributions for Federal Income Tax Purposes. N.C. LAW REQUIRES POLITICAL COMMITTEES TO REPORT THE NAME, MAILING ADDRESS, JOB TITLE OR PROFESSION AND NAME OF EMPLOYER OR EMPLOYER'S SPECIFIC FIELD FOR EACH INDIVIDUAL WHOSE CONTRIBUTIONS AGGREGATE IS IN EXCESS OF $50 IN AN ELECTION CYCLE.

Select Payment Method
Personal Info

Credit Card Info
This is a secure SSL encrypted payment.

Donation Total: $100 One Time