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Donations - Secure Online Donation Form

Campaign/Fund Information
Campaign/Fund * PAC
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Donation Information
Donation Amount *

Payment Method * Credit Card
Donation Type *


Number of Payments *  
First Name *
Last Name *
Address 1 *
Address 2
City *
State *
State Abbreviation
Zip Code *
Occupation  *
Phone Number
Donor Comments
Donor Information
First Name *
Middle Name
Last Name *
Suffix
Organization
Email *
Address *
Address Cont.
City/Town *
Country *
State
Postal Code*
Phone *
Billing Information
[ Click here if billing address is the same as donor address ]
 *  
Organization 
Address *
Address Cont.
City/Town *
Country *
State
Postal Code*
Billing Phone *


FAPA HEADQUARTERS
222 S. Westmonte Drive, Suite 111
Altamonte Springs, FL 32714
PHONE: (407) 774-7880 | FAX: (407) 774-6440
fapa@fapaonline.org



 

 

FAPA Mission Statement: Empower, represent, and advocate for Florida PAs

 

FAPA Vision: Fully integrate PAs into every aspect of health care in Florida.


 

 

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