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MITT ROMNEY
Source: Sunlight Foundation's Party Time www.politicalpartytime.org. The Sunlight Foundation collects these invitations from anonymous lobbyist sources.
Mitt Romney
RS
Source: Sunlight Foundation's Party Time www.politicalpartytime.org. The Sunlight Foundation collects these invitations from anonymous lobbyist sources.
- R.S.V.P. Breakfast Reception with Mitt Romney, Friday, Sept. 16, 2011
Reply Information
Yes, I/we will be attending the September 16th Private Reception with photo opportunity at 8:00 a.m. Enclosed is my/our contribution of $ __________ ($2,500 per couple). Yes, I/we will be attending the September 16th General Reception at 8:30 a.m. Enclosed is my/our contribution of $ __________ ($500 per person/$1,000 per couple). No, I am unable to attend but would like to support Mitt Romney for President. Enclosed is a contribution of $100 $250 $500 $1,000 $2,500 or $__________________. Please make your check payable to: Romney for President, Inc. Name_______________________________________________________________________ Address______________________________________________________________________ City___________________________________________ State________ Zip______________ Home Phone___________________________ Work Phone____________________________ Email_______________________________________________________________________
Contribution Information This contribution is made by check or credit card from my personal funds and is not drawn on an account maintained by an incorporated entity. I am a U.S. citizen or permanent resident and this contribution will not be reimbursed by another person. Signature____________________________________________________ By law, the maximum amount an individual may contribute is $2,500 ($5,000 per couple) per election. For a contribution from a joint account to be attributed to two individuals, both must sign this form, indicating agreement with the above statement. Joint Contributor Signature______________________________________ Federal law requires us to obtain and report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $200 per election cycle. Please complete the following: Occupation_____________________________________________ Employer______________________________ Joint Contributor Name_________________________________________________________________________ Joint Contributor Occupation______________________ Joint Contributor Employer________________________ Credit Card Reply Please charge my contribution of $________________ to my credit card. Visa MasterCard AMEX Discover Account Number___________________________________________________ Exp. Date___________________ Name on Card__________________________________ Signature_______________________________________ Mail to: Romney for President, Inc., c/o Karolyn Dorsee, Dorsee Productions, P.O. Box 455, Rancho Santa Fe, CA 92067 - Phone: (858) 756-2027 - Fax: (858) 756-2597 Email: karolyn@dorseeproductions.com Fundraiser ID: ____________________ Source Code: ECA011
Contributions are not tax deductible as charitable contributions for federal income tax purposes. Contributions by corporations, foreign nationals (non-green card holders), labor unions, federal government contractors, and minors under the age of 18 are prohibited.
www.MittRomney.com
Source: Sunlight Foundation's Party Time www.politicalpartytime.org. The Sunlight Foundation collects these invitations from anonymous lobbyist sources.