SDPT-PAC Pledge
I understand the need for SDPT-PAC to be in a strong position to help candidates who are responsive to the physical therapy profession’s goals and viewpoints. Enclosed is my club membership contribution of:
____$1,000 ____$500 ____$250 ____$100 ____$50 ____$25 ____Other
Platinum Diamond Gold
Double Eagle Eagle Capital
Please make checks payable to SDPT-PAC. Personal checks preferred.
Please forward payments to:
Big Stone Therapies
Attn: SDPT-PAC
309 Washington Ave.
Ortonville, MN 56278
***Do we have your permission to include your name and pledge level on the
website? _____Yes _____ No
** Federal law requires that we request the following information:
Printed Name: __________________________________________________________
Signature: ______________________________________________________________
Address: (No P.O. Box) ___________________________________________________
City: State: Zip: __________________________________________________________
Phone: _________________________________________________________________
Employer: ______________________________________________________________
Date: ___________________________________________________________________
E-Mail: __________________________________________________________________
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