OOPAC Contribution Form Current

A Strong OOPAC - Protecting and Enhancing Optometry's Future!

A target of $240 annually from each OOA member is needed to maintain a healthy OOPAC

Corporate contributions are prohibited. However, partnerships, LLCs and other unincorporated entities may contribute but must provide the name of an owner to whom to attribute the contribution. Ohio law requires that all contributors must provide their name and address regardless of the amount of the contribution and the name of their employer if the contribution is for more than $100. If the contributor is self-employed, the business name and occupation of the contributor must be provided. This form is intended for OOA MEMBERS.

Basic Information

First Name
Middle Name
Last Name
Employer Name
City State Zip
Phone Fax

One-Time OOPAC Contribution

Make a one-time payment via credit/debit card.
 Amount to be charged:
 If 'other', please specify amount: $
Click "Next" to advance. On the following screen, be sure to hit "Submit" to finalize your contribution.

Make this a recurring monthly contribution!

Check the box below if you are interested in contributing automatically to OOPAC each month. You can choose to have contributions withdrawn from your checking account or charged to your credit/debit card. Check the box below and complete the separate OOPAC AutoPAC Enrollment Web Form linked in your confirmation email.
 Yes; I'm interested in monthly OOPAC contributions:
   - denotes required fields