Support NCMS PAC Today!

Complete this two-step secure online form using a personal credit card or fill in information, print, and mail it along with your personal check. Mail to: NCMS PAC, PO Box 25834, Raleigh, NC 27611.
Help us make a difference! By enrolling as a member of NCMS PAC you can join the fight to protect your practice and your patients.

Enrollment Form (Step 1)

Current Status*
  Other, Please Specify
First Name*
Last Name*
Practice Name
Address 1*
Address 2
City* | State* | Zip*

Choose How You Would Like To Support the NCMS PAC

  I Want To Become a Sustaining Member!
A Sustaining Member is a committed NCMS PAC supporter who understands the importance of backing political candidates who are friends of medicine. By selecting this option, you are permitting the NCMS PAC to automatically renew your donation on an annual or monthly basis, based on the credit card information and option you designate below.

Membership Level*

  I Prefer To Make a One-Time Gift

Other Amount

*Denotes a required field.
NC 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 contribution's aggregate is in excess of $100 in an election cycle.

Contributions to NCMS PAC are not tax deductible as charitable contributions for federal income tax purposes. Voluntary contributions to NCMS PAC are not limited to the suggested amounts and should be written on a PERSONAL CHECK. 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. Neither the AMA nor the NCMS will favor or disadvantage anyone based upon the amounts of or failure to make PAC contributions. Copies of NCMS PAC 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.)