New Jersey STATPAC
 
New Jersey STATPAC Contribution

Right now, lawmakers and government officials, not trained in medicine, are making decisions on legislation that may affect our specialty and how we provide our patients with care. It is important that emergency physicians continue to band together and aggressively continue the role of patient advocates.

STATPAC is an effective and efficient way to help us communicate our views to legislators. Help assure that STATPAC will be able to impact on the important legislative issues that affect you and your patients.

We would like you to consider STATPAC contributions to be part of your expenses, just as you do for CME, insurance, living expenses, etc. We are proposing the equivalent of an average contribution of 3 hours of pay or $300 per member.

* = Required

Contributor Name*
Email*
Confirm Email*
Contributor Address (number and street)*
City*
State*
Zip Code*
Employer Name*
Employer Address (number and street)*
City*
State*
Zip Code*
Contribution:* $500 Leader Level
$400 Pioneer Level
$300 Benefactor Level
$200 Contributor Level
$100 Supporter Level
$

THANK YOU FOR YOUR CONTINUED SUPPORT.

Contribution


Or you may print this PDF
and mail the completed form with your payment to:
Parker Allen
c/o NJ-ACEP 201 E. Main Street, Ste. 1405
Lexington, KY 40507
or fax it to (859) 514-9188