Categories
$1000
Capitol Hill Club Member (One Payment)
$1000 Captiol Hill Club Member
(Please make automatic equal monthly
charges to my credit card)
$300
Sustaining Member
$100
Spouse Member
$50
Retired Physician
$15
Residents and Medical Students
Payment
Method
Personal
Credit Card
TMA staff will
call you concerning information for the charge to your credit
card.
Personal
Check
Please
print this form and mail with your check made
payable to
IMPACT, PO Box 120909, Nashville, TN,
37212-0909.
Please
Read . . .
IMPACT
(Independent Medicine’s Political Action
Committee — Tennessee) is a separate segregated
fund established by the TMA. AMPAC is a separate
segregated fund established by the AMA.
No portion
of IMPACT or AMPAC dues can be deducted as a business
expense on federal income tax returns. Neither
TMA/AMA membership dues nor PAC contributions may be
deducted as charitable contributions.A portion of
your contribution, not to exceed $50, pays your
sustaining dues in AMPAC, a federal PAC supporting
candidates for the U.S. House and Senate who are
friendly to organized medicine.
You are urged to
use a personal check to pay your annual dues for
IMPACT/AMPAC. Funds from corporations cannot be
used for contributions and expenditures in either
federal or state elections.
Contributions
are subject to the limitations of FEC Regulations,
Section 110.1, 110.2 and 110.5. (Federal regulations
require this notice.) Copies of IMPACT and AMPAC
reports are filed with the FEC and are available for
purchase from the Federal Election Commission,
Washington, DC.
Contributions
of more than $200.00 – To comply with Federal
law, we must use best efforts to obtain, maintain,
and submit the name, mailing address, occupation and
name of employer of individuals whose contributions
exceed $200 per calendar year.
Neither
the AMA nor the TMA will favor or disadvantage anyone
based upon the amounts or failure to make PAC
contributions.
Thank you
for your membership in IMPACT.