Thank you for your pledge in support of LUGPA’s legislative advocacy!

LUGPA’s leadership hosts fundraising events throughout the year for members of Congress who serve in leadership positions or on important committees of healthcare jurisdiction. These impactful events allow us to engage in detailed and intimate conversations with policymakers regarding issues that affect independent urology.

Your group’s pledge represents the total personal contributions from individual physicians within your group (up to $3,300 per person per election). On average, individuals typically contribute $500 per physician. Please note that corporate funds are prohibited by law from being used for political action contributions.

LUGPA’s advocacy efforts are bipartisan. You can allocate your group’s pledge between Democratic and Republican members of Congress. Our team will use these pledges to recommend contribution levels to legislators who are pivotal to our advocacy efforts. We will organize a series of events throughout 2025 to support these members. Timely pledges from your group are essential for effective planning.

While we respect your preference in fund allocation, please understand that we may request contributions to legislators outside your local region. We aim to support influential nationwide policymakers who align with our legislative priorities.

Please complete the form below, which represents your group’s commitment to an upcoming fundraiser. We will contact you 4-6 weeks in advance of the fly-in events with instructions on how to contribute. Physicians will be asked to make personal checks payable directly to specific members of Congress, not to LUGPA. Your group may be contacted later in the year to fulfill your contribution commitments.

Once again, thank you for your assistance in our mutual critical advocacy efforts. Please do not hesitate to contact Celeste Kirschner at celeste.kirschner@lugpa.org with any questions.

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Practice Name

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Your Name

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Your Cell Phone Number

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Your Email

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Practice Address

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Pledged amount $ (Please note this is the total dollar amount in aggregate of contributions from your group's physicians)
Whole numbers only, no punctuation 

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Of the total dollar amount pledged from your group, please specify how much your group wishes to contribute to members of either party, if you wish. If you have no preference and will support the legislator LUGPA finds most impactful regardless of party, you may leave this section blank. Please note that if you split your pledge, we may need to collect the funds allocated to the Republican/Democrat at two separate times during the year.

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I understand corporate funds cannot be used to fund political action and checks will go directly to a campaign and not to LUGPA

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Please check this box to indicate that your group has given you the authority to make this pledge.

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