MDS CE Transcript & Radiology Certificate Request Form
Voluntary Contribution Secure Credit Card Form

Please select the amount you wish to contribute below or add an optional other contribution amount. Then click the Make Contribution button to continue.

$145 Sustaining Member

$250 Beacon Hill Club

$500 Governor's Club

Other Contribution Amount :

Voluntary Contribution Form Legal Disclaimer

The first $49 of your contribution is designated to ADPAC and the remaining amount is designated to the MDS-PAC. A contribution of any amount includes membership in both MDS-PAC and ADPAC. Please contact the MDS promptly at (800) 342-8747 to change the distribution of your contribution. ADPAC support dentistry at the Federal level and MDS-PAC supports dentistry at the State level.

Contributions made to MDS-PAC and ADPAC are voluntary. Contributions made to MDS-PAC will be used, in part, to make contributions to candidates for election to state level office in Massachusetts. MDS-PAC/ADPAC contributions are not limited to the suggested amounts. The indicated contribution amounts are merely suggestions and are not required amounts.

If your practice is incorporated, contributions to the MDS-PAC and ADPAC must be written on a PERSONAL check or PERSONAL credit card and will be distributed under the limits of campaign finance law and policies set forth by MDS-PAC and ADPAC. Massachusetts law prohibits political contributions made by corporate check or corporate credit card. Neither the ADA nor the MDS will favor or disadvantage anyone based upon the amount of or failure to make PAC contributions. Copies of the MDS-PAC reports are on file with the Commonwealth of Massachusetts at the Office of Campaign and Political Finance; ADPAC reports are filed in accordance with federal regulations. Contributions are not deductible for federal or state income tax purposes. State law requires political committees to report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $200.00 per calendar year; federal law requires the same information for each individual whose contributions aggregate in excess of $200.00 per election cycle.

Questions or concerns? Please contact Kevin Monteiro, Manager, Grassroots and Political Advocacy.

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