NYAPAC Contribution Form

NYAPAC Contribution Form
Supporting NYAPAC is one way you can help shape the future of your profession and advocate for your patients. Your contribution strengthens our collective voice in Albany, allowing us to engage with policymakers and support candidates who understand the challenges facing anesthesiologists and the communities we serve. By providing your support, you demonstrate a strong commitment to protecting and advancing your profession.

All contributions to NYAPAC are pooled into a single fund and, in accordance with state law, individual contributions cannot be earmarked for any specific candidate.
In New York State, contribution limits to Political Action Committees (PACs) are set by election law and differ for individuals vs. corporations.
Individuals: Up to $138,600 per PAC, per calendar year. No aggregate cap across all PACs
Corporations: Up to $5,000 total per year (aggregate) across ALL political contributions.
POLITICAL CONTRIBUTIONS ARE VOLUNTARY AND NOT DEDUCTIBLE FOR INCOME TAX PURPOSES.
Name*

First NameLast Name
NYSSA District
Email*
example@example.com
A complete home address is required by law for reporting.
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code

Contribution Levels*

Gold Level

One Time Payment

$1,000.00

Silver Level

One Time Payment

$500.00

Bronze Level

One Time Payment

$300.00

Supporter Level

One Time Payment

$225.00

Monthly Gold Level

Charged 7th day of each month

$83.33

Monthly Silver Level

Charged 7th day of each month

$41.67

Monthly Bronze Level

Charged 7th day of each month

$25.00

Other (enter amount)

$1.00 - $5,000.00

$1.00 Enter Amount

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

NYAPAC Contribution Form

In New York State, contribution limits to Political Action Committees (PACs) are set by election law and differ for individuals vs. corporations.

Individuals: Up to $138,600 per PAC, per calendar year. No aggregate cap across all PACs

Corporations: Up to $5,000 total per year (aggregate) across ALL political contributions.

POLITICAL CONTRIBUTIONS ARE VOLUNTARY AND NOT DEDUCTIBLE FOR INCOME TAX PURPOSES.

A complete home address is required by law for reporting.