HOSPAC Individual
Membership Brochure (PDF)
HOSPAC Online Contribution Form

Join HOSPAC to make your voice heard!
Your participation makes the difference.
 HOSPAC Individual and Corporate Reply Form(Microsoft Word)


Please complete the form below.

YES! Add me to HOSPAC team at the following membership level:
$50 - Friend
$100 - Century Club
$250 - Capitol Club
$500 - Chairman's Club*
$1,000 - Millennium Leaders*
$1,500 - President's Council*
$2,000 - Ambassadors*
Other

HOSPAC members receive invitations to special events, thank you gifts, the HOSPAC Notes newsletter, political updates and special recognition in THA and HOSPAC State publications and at important THA leadership events.

* Leadership Members receive complimentary admission to all HOSPAC Receptions and events. Besides offering prominent recognition of Leadership level members, HOSPAC’s popular Leadership Reception Program series of events provides local and regional hospital executives, trustees and community leaders the opportunity to come together on behalf of hospitals to meet personally with important legislators. These events cultivate stronger grasstops and grassroots involvement in support of fair health care policy for Texas hospitals and the patients they serve, while helping to raise needed funds for HOSPAC.

Full Name:  
(Enter name as you would like it to appear on recognition displays.)

Relationship to hospital:
Hospital Staff
Trustee
Friend of Hospital

Title/Occupation:
Department:
Hospital/Health System, Business, or Other Organization:

Site: Work Home
Address:
City: State: Zip:
E-mail address:
Direct daytime phone:

I authorize HOSPAC to charge my credit card for a one-time contribution of $
Card Type:
Billing First Name:
Billing Last Name:
Billing Address:
City: State: Zip:
Credit Card Number:
Expiration Date:

Corporate contributions must be made to the THA Political Education Fund and cannot be made to HOSPAC State or HOSPAC Federal. HOSPAC offers a special corporate membership business level, the President's Council Business Associates ($1,500), with special benefits. If your business is interested in participating please contact HOSPAC's director, Lisa Kepple, via e-mail (lkepple@tha.org) or by calling 512/465-1047. Corporate contributions from non-profits will not be accepted.

If you prefer to make an ongoing, monthly credit card contribution rather than a one-time contribution, please click here to download a reply form, then complete it and mail or fax it to HOSPAC. Or you can contact HOSPAC's director, Lisa Kepple, via e-mail (lkepple@tha.org) or by calling 512/465-1047.

When federal authorization is on file and unless otherwise indicated by donor eligible contributions will be directed toward HOSPAC Federal until the annual Federal PAC goal is met. All other contributions will be directed to the State PAC. Please contact HOSPAC's director, Lisa Kepple, via e-mail or by calling 512/465-1047.

The HOSPAC membership contributions & benefits cycle begins on Jan. 1 and ends on Dec. 31 of the same year. Your membership level is determined by totaling all contributions you make to HOSPAC State, Federal, or through Designated Contributions by Dec. 20th of that same year.

The Texas Hospital Association State Political Action Committee (HOSPAC), is registered with the Texas Ethics Commission, P.O. Box 12070, Austin, TX, 78711-2070. The Texas Hospital Association Federal Political Action Committee is registered with the Federal Election Commission, 999 E St., N.W., Washington, D.C., 20463. A contribution to either State or Federal HOSPAC is not deductible for income tax purposes. Any contribution amount above is "suggested;" you have the right to give any amount or decline participation. Any inappropriate contributions will be returned.

For any questions regarding HOSPAC and/or this contribution form, please contact HOSPAC at 512/465-1047.

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