EyePAC Donation Form

EyePAC Donation Form - Step 1 of 3

THANK YOU for giving or considering a gift to the EyePAC. Your commitment to our mission of promoting quality patient care helps us extend support to elected officials who are representing you and your patients in the General Assembly. Building relationships with our legislators is crucial in order that the message of medicine, and specifically that of eye physicians and surgeons in North Carolina, is heard loud and clear. A primary means of establishing and strengthening those relationships is through EyePAC support.

We are continuing in our effort to achieve medical liability reform and fighting the encroachment of non-MD providers into the practice of medicine. Our efforts cannot be successful without a strong presence and voice in the political and legislative process. You can be assured that our opposition will be doing everything they can to prevail and will be putting tremendous resources behind their positions which can jeopardize patient safety and our profession.

Thank you for your support!

Voluntary contributions to the PAC are not limited to the suggested amount and should be submitted by personal credit card. Funds from corporations cannot be used for contributions and expenditures in either federal or state elections.Voluntary political contributions are subject to the limitations of Federal Election Commission regulations.Contributions are not deductible as charitable contributions for Federal Income Tax Purposes.

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 contributions aggregate is in excess of $50 in an election cycle.


Degree MD
PhD Other (specify)

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