ObesityPAC Donation

• Password*
  To proceed please enter the special password for the ObesityPAC donation form. If you do not know this password email info@obesitypac.org for assistance.

• The password you entered does not match and will not unlock the donation form. This is not your login password for this website. To request the password to donation email info@obesitypac.org. You may go back to enter the password again.

• Please select your giving level and contribution method below. If you are currently a member of ObesityPAC and wish to increase your contribution, please enter your new contribution amount below. The amounts below are merely suggestions; contributions in all amounts up to $5,000 are accepted and appreciated.

• To associate your donation to your ASMBS members account, you must be logged in to this website.

  Click here to login and redirect back to this page.

• Full Name*
  Enter your full name. This name will be used to sign the statement prior to completing your donation.
• Email*
• Address 1*
• Address 2
• City*
• State*
  AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific
• Zip*
• Employer*
• Occupation*

• Please review your information before continuing.

• Pledge Your Support

  Option 1: One-time credit card

  Please enter the amount you would like to contribute to the ObesityPAC.

  Option 2: Recurring Credit Card

  Please select or enter the recurring payment amount you would like to contribute to the PAC each month. Your credit card will be charged every month until you cancel your payments. To cancel your monthly payments anytime, please email info@obesitypac.org.

  Choose a donation option and amount

  Select one amount in either option. To change your amount, unselect your previous choice.

• OPTION 1 - One-Time Credit Card
  • $250 once
  • $500 once
  • $1,000 once
  • $2,500 once
  • $5,000 once
  • Other
• OPTION 2 - Recurring Credit Card (monthly)
  • $21/month ($252/year)
  • $42/month ($504/year)
  • $84/month ($1,008/year)
  • $209/month ($2,508/year)
  • $416/month ($4,992/year)
  • Other
• One-Time Donation to ObesityPAC - Personal
  Price:
• Select a donation option
  Price:
• One-Time Donation to ObesityPAC - Personal
  Price:
• One-Time Donation to ObesityPAC - Personal
  Price:
• One-Time Donation to ObesityPAC - Personal
  Price:
• One-Time Donation to ObesityPAC - Personal
  Price:
• One-Time Donation to ObesityPAC - Personal*
• Recurring Monthly Donation to ObesityPAC - Personal
  Price:
• Recurring Monthly Donation to ObesityPAC - Personal
  Price:
• Recurring Monthly Donation to ObesityPAC - Personal
  Price:
• Recurring Monthly Donation to ObesityPAC - Personal
  Price:
• Recurring Monthly Donation to ObesityPAC - Personal
  Price:
• Recurring Monthly Donation to ObesityPAC - Personal*

• Monthly Recurring Donation to Obesity PAC
  $0.00
• One Time Donation to ObesityPAC
  $0.00
• Credit Card
  Card Details

  Cardholder Name
• Authorization*

  ObesityPAC Donation Policies

  Contributions to ObesityPAC are not deductible as charitable contributions for federal income tax purposes. Contributions are voluntary, and all members of ASMBS have the right to refuse to contribute without reprisal. Federal law prohibits ObesityPAC from accepting contributions from foreign nations. Federal law requires ObesityPAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. ObesityPAC is a program of the ASMBS, which is exempt from federal income tax under section 501 c (6) of the Internal Revenue Code.

  • I have read & understand the policies.
• Citizenship Requirement*
  • Please check to indicate that you are a U.S. citizen or a foreign national admitted for permanent residence.
• Full Name
  Please type your name in the signature field exactly as it appears in the box below.
• Signature*

Submit

Contributions to American Society for Metabolic and Bariatric Surgery Political Action Committee, Inc. (ObesityPAC) are not deductible as charitable contributions for Federal income tax purposes. ObesityPAC is funded by voluntary contributions. You have the right to refuse to contribute without reprisal. Contributions will be used for political purposes. Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and name of employer of individuals whose contributions exceed $200 in a calendar year. The recommended contribution amounts are only suggestions. You may give more or less than the suggested amount. The American Society for Metabolic and Bariatric Surgery will not favor or disadvantage anyone by reason of the amount of their contribution or their decision not to contribute. Contributions must be made with personal funds only. You must be a US citizen or permanent resident (green card holder) to contribute.