Are you an American for Free Choice in Medicine?
Yes! I am an American for Free
Choice in Medicine. I wish
to support my principles with a
tax-deductible donation.
Name:
_____________________________
Mailing Address:
_____________________________
_____________________________
_____________________________
E-mail Address:
_____________________________
Donation Amount:
______ Paul Revere: $40–$99
______ Patrick Henry: $100–$249
______ Thomas Paine: $250–$499
______ George Washington: $500–$999
______ Thomas Jefferson: $1,000 or more
Please make check payable to AFCM and mail to:
Americans for Free Choice in Medicine
1525 Superior Avenue
Suite 101
Newport Beach, CA 92663
Thank you for your donation!
AFCM is a 501(c)3 non-profit organization, and contributions are tax-deductible to the extent provided by law.