Home / Upcoming Events / Indiana Council PAC RegistrationIndiana Council PAC Registration Please enable JavaScript in your browser to complete this form.Attendee Name *FirstLastAttendee NameFirstLastAttendee NameFirstLastAttendee NameFirstLastAttendee NameFirstLastAgency/Firm *Email *Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeTotal Number of Attendees From Your Organization *Please make checks payable to: Friends of Indiana Mental Health Centers Questions: Contact Denise Wade at: 317-684-3684 or dwade@indianacouncil.org. Personal contributions are a great way to support your PAC. Feel free to use this form along with your personal contribution to support the public policy efforts of the mental health industry in Indiana. This contribution is not tax deductible, however, it will go a long way to make sure our voice is heard at the Indiana Statehouse!Submit