The Unified Legislative Committee would like to encourage every member of our profession to contribute to the Unified’s ChiroPac.  If every chiropractor in Oklahoma would give just $10.00 per month, we would have $72,000.00 per year, and almost $150,000.00 per election to help our friends in state public office.  JUST $10.00 PER MONTH!!!  Don’t think someone else will do your part for you. Take the responsibility and contribute today.  Get involved with the Unified Chiropractic association and a national organization.  APATHY IS KILLING US!  If you already contribute individually to your state representatives, let them know that you support the Unified OSCA/JCA legislative agenda and make sure you inform the JCA/OSCA Unified Chiropractic Association at 918-224-6078 who those legislators are so we can use your influence in key situations.  Our profession depends on every one of us doing our part.
A one-time $200.00 contribution or $20.00/mo. electronic funds transfer (EFT) will entitle you to one-year free membership to the Unified Chiropractic Association.  Please use the authorization (below) to contribute by monthly electronic debit, or fill out the form for single mail-in contributions.  Please remember we cannot accept corporate money per the Ethics Commission rules.
OSCA/JCA Legislative Committee

(Mail with your contribution to Unified PAC, P.O. Box 701421, Tulsa, OK 74170) Contributor Statement Contributor’s Name:_______________________________________________, Doctor of Chiropractic Address:____________________________________________________________________________ I acknowledge that on _______________, 2012, I contributed or pledged $_________.00  to the Chiropractic Political Action Committee (ChiroPAC) _____ personal check ______ cashier’s check ______money order ______ 12 equal personal bank drafts This contribution was freely and voluntarily given by me from my personal funds.  I have not, directly or indirectly, been compensated or reimbursed for this contribution. Signature:____________________________________ (This form is required of all personal contributions by the Rules of the Oklahoma Ethics Commission)

Official Political Action Campaign (PAC) Bank Debit Contract

I, Dr. ___________________________________________ hereby authorize the

Unified Legislative Committee’s ChiroPAC

to initiate monthly debit entries of $______.00 from my PERSONAL checking account for one year or until written notification of my termination; for the purpose of legislative lobbying for the Chiropractic profession in Oklahoma.


Signature_____________________________________    Date_____________________