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TN-PAC Contribution Form (Secure Form)
(Please select one of the two options below.)
I am contributing $ to TN-PAC today!
OR
I pledge $ to TN-PAC. Half of the total pledge will be paid now (i.e.: charged to my credit card today) and the other half will be paid (charged to my card again) in six months. (The second credit card transaction is automatic. No additional action will be required.)
Payment Information
Payment by:
MasterCard
VISA
Discover
American Express
Account Number:
Exp. Month: Year:
Check: Please print this form and mail with check payable to Tennessee Nurses Political Action Committee (TN-PAC) to TNA, 545 Mainstream Dr., Ste. 405, Nashville, TN 37228
TN-PAC Supporter Information
Full Name:
Address:
City: State: Zip:
Work Phone: Home Phone:
Fax: Email:
* If paying by check, print this form and mail with your payment to:
Tennessee Nurses Political Action Committee
545 Mainstream Drive, Suite 405, Nashville, TN 37228-1296
Phone: 615-254-0350 Fax: 615-254-0303
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