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					                                  MEMBERSHIP DUES INVOICE
                                  JANUARY 1 – DECEMBER 31
                                                 2011
Jefferson County Medical Society                                                       $175.00
Texas Medical Association (required for local membership)                              $435.00
American Medical Association (optional)                                                $420.00
TEXPAC/TEXPAC Statewide/AMPAC*                                                         $_____
       ($125 or $300 Club Membership)
Other (Physicians Benevolent Fund, AMA-ERF)                                            $_____
 (optional & deductible as charitable contribution)
Paul R. Meyer Student Loan Fund                                                        $_____
 (optional & deductible as charitable contribution)

                                                               TOTAL                   $_____

Members of the Jefferson County Medical Society are also members of the Texas
Medical Association.

PLEASE MAKE CHECK PAYABLE TO: TEXAS MEDICAL ASSOCIATION
                       Mail to: TMA, Membership Department
                                401 W. 15th Street
                                Austin, TX 78701

    Voluntary political contributions to TEXPAC are shared with AMPAC. Neither TMA nor AMA will favor
or disadvantage anyone based on the amounts or failure to make contributions. Additionally, no portion
of any dues paid to TEXPAC or AMPAC may be deducted as a business expense for federal income tax
purposes. Furthermore, federal law required political committees to report the name, mailing address,
occupation, and name of employer for each individual whose contributions aggregate in excess of $200 in
a calendar year.
   A portion of dues may be tax deductible as ordinary and necessary business expenses. Texas
Medical Association estimates that 18% of your 2006 TMA dues will be nondeductible and the American
Medical Association estimates that 29% of your 2006 AMA dues will be nondeductible, as those portions
are allocable to lobbying as defined by law.
   Contributions or gifts to the above designated entities, with the exception of the Physicians’
Benevolent Fund, are not deductible as charitable contributions for federal income tax purposes.
Contributions to the Physicians’ Benevolent Fund, however, are deductible as charitable
contributions for federal income tax purposes.
   $20 of TMA regular member dues is for one-year subscriptions to Texas Medicine. Please return this
invoice with your remittance.

Members Name:________________________________________________________
                                (Please Print)

				
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posted:6/19/2011
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