PsychMD-PAC Contribution Form

Senator Creigh Deeds accepts award for
Legislator of the Year from the Psychiatric Society of Virginia

Pictured from left to right Susan Waller, MD, Varun Choudhary, MD, Rizwan Ali, MD, PSV President, Senator Creigh Deeds, Brian Wood, DO, PSV President Elect, Helen Foster, MD, Adam Kaul, MD, Past President, Caroline Coster, MD

Donate to PsychMD PAC

Help PSV join Legislators at the decision-making table.

PsychMD PAC is your profession's voice in the political process. Contributing to the PAC is investing in your profession, patients, and high-quality health care from psychiatrists. A robust PAC helps ensure that policymakers understand that psychiatrists are leaders and experts in mental and behavioral health, and that you are committed to helping your patients not only through providing care but also being strong advocates for sound policy.

PsychMD PAC is a critical tool in our advocacy program. It allows us to support legislators who are friendly to our profession and issues in the General Assembly. Every year the legislature considers bills that could potentially impact our profession and patients. A strong PAC provides us the opportunity for our voice to be heard by elected officials in the legislature and executive branch. Our PAC enables us to support legislators who support our profession. Our goal is to keep Delegates and Senators who are friendly to our issues in the legislature.

Federal and State law require PsychMD-PAC to use its best efforts to collect and report the name, mailing address, and name of employer of individuals whose donations exceed $100 in an election cycle. Contributions are not tax deductible.

CONTRIBUTOR

First Name:

Last Name:

Degree:

MD PhD
Other (specify)

CONTACT INFORMATION

Mailing Address:

City:

State:

Zip:

Email Address:

Required by State Election Law:

Employer or Business:

Principal Place of Business (city/county):

CONTRIBUTION

$500.00 (Leadership Circle)
$250.00 (Advocate)
$100.00 (Member)
Other: $

PAYMENT TYPE

One-time payment
Monthly recurring payment (starting 4/2023 and ending 12/2023)
If you select this option the full contribution amount selected above will be applied each month

PAYMENT OPTIONS

Credit Card Type:

VISA MasterCard AmEx Disc

Card Number:

Security code:

For VISA or MasterCard it is on the back of your card in the signature box. The 3-digit code is printed on the right-hand side of your 16-digit credit card number.
For American Express the code is the 4-digit number printed on the front of your card either on the right-hand side directly above the credit card number or the left-hand side directly above the credit card number.

Expiration Date:

Card Holder Name:

Senator Creigh Deeds accepts award for Legislator of the Year from the Psychiatric Society of Virginia

Donate to PsychMD PAC

Help PSV join Legislators at the decision-making table.

Senator Creigh Deeds accepts award for
Legislator of the Year from the Psychiatric Society of Virginia