2025 Midyear Meeting PAC Reception Registration & Contribution Form

This field is for validation purposes and should be left unchanged.

Registration contributions for the PAC must be personal funds (not corporate funds).

Name(Required)
Home Address(Required)
Email(Required)
Please include dashes for phone number entry. Ex: 123-456-7890
Suggested Contributions for Individuals
Suggested Contributions with a Guest
* 1 additional prize raffle entry awarded for each additional $100 contributed above the highest suggested levels.
For Non-US Citizens only, please select which fund you would like your contribution allocated to:

These contribution amounts are suggested amounts only and your participation at the PAC reception is voluntary. Your level of contribution or non-participation in this event will have no impact on other business you have with CMHA. Cash cannot be accepted. By law, only personal funds (not corporate) may be accepted by the CMHA PAC. Campaign contributions are not tax deductible.

Your order invoice will be created and forwarded to you via email. If you have questions, please contact Sheila Thomas, 571-224-0937.

For questions related to the event, contact Erin Hobson, 703-657-6908 or Dana Hartung, 703-457-1107.