Washington ACEP PAC Contribution Form


The WA-ACEP PAC supports efforts to strengthen emergency medicine at the local and state levels in a bipartisan manner.

Contact Information

Name:
Title:
Hospital/Group Name:
Address:
Phone:
-
E-mail:*

Contribution Amount

PAC Coffee Club Contribution:
Other Contribution Amount:
 $ 
Spouse's Name (for contributions of $100 or more):
Total:
Please verify:

Upon completing the form and clicking "submit," you will be directed to PayPal to make the contribution.

INQUIRIES
Contact Pauline Proulx, Chapter Executive, at the Washington ACEP office at 206-956-3648 or send emails to plp@wsma.org