FamilyMedPAC
Objectives

*State Public Disclosure Commission regulations requires Washington FamilyMedPAC to report the name, address, occupation, and name of employer for anyone who contributes $100.00 or more in a calendar year.

Name *

First

Last

Title

AAFP ID # (if applicable)

Email *

Address

Address Line 1

Address Line 2

City

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Zip Code

Occupation

Employer

Employer City

Employer State

Contribution Amount *

Comment or Message *

Submit