Making a contribution to the Michigan Pharmacy Political Action Council (PAC) will allow you to become a part of the united voice protecting pharmacy. Pharmacy PAC is an important advocate promoting a pharmacy-friendly legislative agenda. Please complete the form below to make a contribution to Pharmacy PAC.

Employer name, occupation and credit card designation (personal or corporate) is required per state election laws and to ensure compliance with federal finance law. Pharmacy PAC may only utilize personal contributions to support political candidates.

PAC Donation Form

First Name *

Last Name *

Primary Email Address *

Primary Phone Number *

Mailing Address

Street Address *

City *

State/Province/Region *

Zip/Postal Code *

Is your billing address the same as your mailing address? *

Billing Address

Street Address *

City *

State/Province/Region *

Zip/Postal Code *

Employer or Name of Business *

Occupation? *

Business Street Address *

Business City *

Business State *

Business Zip Code *

Business Phone Number

Business Email Address

Donation Details

Donation Amount *

This is a *

Personal

Corporate

Donation Comments