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Litigation Fund Contributions

TCA'S LITIGATION FUND

If you don't wish to contribute on-line, you may download our forms here for mailing or faxing.

Donations to PAC and Litigation Funds are not deductible as a charitable contribution but may be deductible as a business expense. Consult your tax-advisor for details.

You may contribute to the PAC or Litigation Fund by filling out the secure form below. Please note in the "Comment" box at the bottom of the form which fund you would like to donate to. If you don't indicate a preference, the TCA will use your funds where they are most needed.

Thank you for helping us help Chiropractic!

See Privacy and Refund Policies here

Donation

* Mandatory fields
*First name
*Last name
*Company or Clinic Name:
*e-Mail
*Phone
 

PLEASE COMPLETE EACH SECTION, THE SECURITY CHECK (IF VISIBLE), AND CLICK NEXT AT BOTTOM

TO MORE ACCURATELY IDENTIFY YOU please supply your Chiropractic License Number: (students disregard)
 

WHAT AMOUNT AND TO WHERE DO YOU WISH TO CONTRIBUTE?

*Amount ($USD)
*Contribution to:
*Do you wish this charge to recur monthly?
 

COMPLETE THIS SECTION FOR CHARGES THAT ARE TO RECUR EACH MONTH (see Privacy & Refund Policies)

Please provide credit card number here as well as the next page.
Please provide expiration date
CVV (3-digit number on the back of the card or 4-digit number on the front for amex-type card)
Billing address
City
State / province
Postal code
Country
Contact Phone Number:
 

ADD ANY COMMENTS HERE, COMPLETE SECURITY CHECK (IF VISIBLE) AND CLICK "NEXT"

Comments or instructions?

Security check

* Code
 
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Texas Chiropractic Association
1122 Colorado Street, Suite 307 Austin, Texas 78701   
Telephone 512.477.9292    Fax 512.477.9296     
info@chirotexas.org