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 roles or on key healthcare committees. These impactful events allow us to engage directly with policymakers on issues that affect independent urology practices.

Your group’s pledge represents the total personal contributions from individual physicians within your group (up to $3,500 per person, per election under current FEC rules). Please note that corporate funds cannot be used for political contributions. LLCs taxed as partnerships may contribute, but contributions must be properly attributed to individual members.

LUGPA’s advocacy efforts are bipartisan. You may allocate your group’s pledge between Democratic and Republican members of Congress. Our team uses these pledges to recommend contribution levels to legislators most pivotal to our advocacy priorities. A series of events will be organized throughout 2026 to support these members, and timely pledges are essential for planning.

While we respect your preferences for allocation, please understand that we may request contributions to influential legislators outside your local region who play critical roles in shaping national healthcare policy.

Important Compliance Reminders:
  • Contributions must be made from personal funds by U.S. citizens or green card holders.
  • All checks must be made directly to candidates, not to LUGPA—federal law prohibits bundling or forwarding contributions.
  • Contributions are not tax-deductible.
  • Participation is strictly voluntary. You may decline without fear of reprisal, and LUGPA will not favor or disadvantage anyone based on contribution decisions.
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 each event with instructions on how to contribute. Physicians will be asked to make checks payable directly to specific members of Congress. Your group may be contacted later in the year to fulfill remaining 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.

Question Title

Practice Name

Question Title

Your Name

Question Title

Your Cell Phone Number

Question Title

Your Email

Question Title

Practice Address

Question Title

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

Question Title

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.

Question Title

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

Question Title

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

T