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YES! I’d like to make an Unrestricted Giving contribution to the Wisconsin Dental Political Action Committee (WIDPAC). I understand that my contribution will be used at the discretion of the WIDPAC Board to support state-level candidates who are proven supporters of oral health.

Contributions are voluntary and any amount is welcome. The following levels receive special recognition, including a dated lapel pin, dedicated WIDPAC communications and WDA Journal/WDA.org listings. (If you contribute to both Unrestricted Giving and Direct Giver, those amounts are totaled to determine your overall giving level.)

Bronze Level - $50
Silver Level - $250
Gold Level - $500
Platinum Level - $1,000+

Cardholder first name *

Cardholder last name *

Contributor Name (if different)

Billing Address *

Billing City *

Billing State/Province

Billing State *

Billing Zip *

Phone number

Occupation *

Payment amount *

*Paid for by the WI Dental Assn PAC. Contributions are not deductible as charitable for tax purposes. Wisconsin law requires political committees to request the name, address, and occupation for each person whose cumulative contributions exceed $200 in a calendar year. Wisconsin law also prohibits contributions from corporations or LLC's taxed as a corporation, contributions must be from a personal account. The contribution guidelines are just suggestions; contributions are voluntary and a member may contribute more, less or not at all without concern of favor or disadvantage by the association. Contribution limits: Under Wisconsin law, individuals may make unlimited contributions to the WI Dental Assn PAC.

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