Contribute

MN Dental PAC

To contribute to MINDENPAC, complete the form below.

MINDENPAC CONTRIBUTION*
- Governor's Club $500
- Senator's Club $250
- Representative's Club $150
- PAC Member $75
- Student Member $25
- Other Amount
Other MINDENPAC Contribution Amount*
What district dental society are you from?*
Name*
First Last
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Total
$0.00
Method of Payment*
- PERSONAL Credit Card
- PERSONAL Check
Note: Per Minnesota law, a political action committee cannot accept funds from a corporate/business account.
Please make personal check payable to MINDENPAC and mail to:
MINDENPAC
1335 Industrial Blvd.
Minneapolis, MN 55413
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Credit Card

American Express
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MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

Note: Per Minnesota law, a political action committee cannot accept funds from a corporate/business account.

Minnesota Dental Association