Contribution Form

Complete this contribution form and mail it to:

Emergency Medicine Action Fund
PO Box 619911
Dallas, TX 75261-9911

Fax it to 972-580-2816 or send a pdf by e-mail.

Contributions can be made as an individual, as part of a coalition combining resources, or as a physician group.

Please call 800-798-1822 to make a contribution over the phone or for questions about the contribution process.

Thank you for helping to influence the regulatory process and shape the future of emergency medicine.