Donate to the Maine Physicians Action Fund

If you have any questions, please contact Shirley Goggin at 207-445-2260. You can donate online below or download the printable PDF donation form.

Donate Online

"*" indicates required fields

Please Select One*

First Name*

Middle Name

Last Name*

Suffix

Address*

Street Address Address Line 2 City State ZIP Code

Phone

Fax

Email*

Employer (Required by election law)*

Contribution Amount*

Credit Card

Billing Address*

Street Address Address Line 2 City State ZIP Code

Stay Connected