Professional Documents
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RUDY BOSCHWITZ
DANA & STEVE ALPETER EVONNE & DIRK BAK STEPHANIE SIMON & CRAIG BENTDAHL KRIS & WARD BREHM KIM & CARL CASALE ANNE & MARTY DAVIS HEATHER & RICK EHRMAN
Reception Thursday, August 23, 2012 REPLY INFO Yes, I will attend the Private Dinner, Photo Reception, and General Reception. Enclosed is my contribution of $ ________ ($50,000 per couple). Yes, I will attend the Photo Reception and General Reception. Enclosed is my contribution of $ _________ ($10,000 per person). Yes, I will attend the General Reception. Enclosed is my contribution of $ _________ ($5,000 per couple / $2,500 per individual). No, I am unable attend, but enclosed is a contribution of $ __________. Please make your check payable to: Romney Victory, Inc. Name_________________________________________________________________________________________ Address_______________________________________________________________________________________ City____________________________________State______________________Zip__________________________ Home Phone____________________________________ Work Phone___________________________________ E-mail_________________________________________________________________________________________ CONTRIBUTOR INFO 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_______________________________________________________________________ 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 collect and report the name, mailing address, occupation, and name of employer of each contributor whose contributions aggregate in excess of $200 in a calendar year (RNC and state parties) or election cycle (RFP). Please complete the following: Occupation__________________________________________ Joint Contributor Occupation___________________________ Employer______________________________________ Joint Contributor Employer_______________________ MasterCard AMEX Discover
CREDIT CARD REPLY Please charge my contribution of $___________ to my credit card. Visa
Account Number___________________________________________ Expiration Date___________________________ Name on Card____________________________Signature____________________________________________________ Mail to: Romney Victory, Inc. c/o Trisha Hamm 2495 Ryan Ave. E St. Paul, MN 55109 Or Fax: 651-846-6579; or Scan/Email to: thamm@trishahammconsulting.com Or Contribute Online Via Secure Site: https://secure.mittromney.com/donate/victory/?sc=EMN004 Fundraiser ID: ________________ Source (or Event) Code: __EMN004__ Proceeds to RV shall be allocated by the following formula: 1. Individuals and non-multicandidate PACsThe first $2,500 will go to RFPs primary account. The next $2,500 will go to RFPs general account. The next $30,800 will go to the RNC. The remaining amount will be split evenly among the federal accounts of the Republican Parties of Idaho, Massachusetts, Oklahoma, and Vermont, up to a maximum of $10,000 per committee. Multicandidate PACsThe first $5,000 will go to RFPs primary account. The next $5,000 will go to RFPs general account. The next $15,000 will go to the RNC. The remaining amount will be split evenly among the federal accounts of the Republican Parties of Idaho, Massachusetts, Oklahoma, and Vermont, up to a maximum of $5,000 per committee.
2.
Notwithstanding this allocation formula, a contributor may designate a contribution for a specific participant or participants. In addition, the allocation formula may change if any contribution would exceed applicable contribution limits. Contributions from corporations, labor unions, federal contractors, and foreign nationals are prohibited. Federal law requires us to collect and report the name, mailing address, occupation, and name of employer of each contributor whose contributions aggregate in excess of $200 in a calendar year (RNC and state parties) or election cycle (RFP).
Paid for by Romney Victory, Inc., a joint fundraising committee authorized by and composed of Romney for President, Inc., the Republican National Committee, the Idaho Republican Party, the Massachusetts Republican Party, the Oklahoma Leadership Council, the Vermont Republican Federal Election Committee, the National Republican Senatorial Committee, and the National Republican Congressional Committee.