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.