You are cordially invited to the Campaign Kick-Off with

___________________________________

John Chapman
___________________________________
CANDIDATE FOR U.S. CONGRESS
AND SPECIAL GUEST

U.S. SENATOR SCOTT BROWN

AT THE

Cape Codder Resort

1225 Iyannough Road
Hyannis, MA

Thursday, January 16, 2014

6:00 p.m.
SUGGESTED CONTRIBUTION TO THE JOHN CHAPMAN FOR CONGRESS COMMITTEE:

$500 per individual | $1,000 per couple

______________________________________________________
R.S.V.P. TO CAROLINE ALCOCK
(617) 538-2967 | CALCOCK@JOHNCHAPMAN2014.COM

Paid for by the John Chapman for Congress Committee

Source: Sunlight Foundation's Party Time www.politicalpartytime.org. The Sunlight Foundation collects these invitations from anonymous lobbyist sources.

2014

JOHN FOR CONGRESS

CHAPMAN

q Y e s , I / w e p l a n t o a t t e n d t h e r e c e p t i o n a n d e n c l o s e d i s m y / o u r c o n t r i b u t i o n o f :

q $ 500 (per individual)

q $ 1,000 (per couple)

q Other $ __________________

q N o , I / w e c a n n o t a t t e n d t h e r e c e p t i o n b u t e n c l o s e d i s m y / o u r c o n t r i b u t i o n o f :

q $ 5,200 (maximum per individual)

q $ 10,400 (maximum per couple)

q Other $ __________________

Name: ____________________________________________________________________________________________________________________
Address: __________________________________________________________________________________________________________________
City, State, Zip:_____________________________________________________________________________________________________________
Phone: qOffice qCell qHome___________________________________ E-mail: ______________________________________________________
Federal law requires the John Chapman for Congress Committee to use its best efforts to obtain and report the name, mailing address, occupation and employer for each individual whose
contributions exceeds $200 in an election cycle.
Occupation(required)___________________________________________Employer(required)_____________________________________________
Signature of Original Contributor: ______________________________________________________________________________________________

Spouse/Joint Contributor Information (if applicable) Spouse/Joint Contributions up to $ 1 0 , 4 0 0 per couple can be accepted on this form
Spouse/Joint Contributor Name:________________________________________________________________________________________________
Occupation(required)___________________________________________Employer(required)_____________________________________________
Signature of Spouse/Joint Contributor:___________________________________________________________________________________________
Phone: qOffice qCell qHome___________________________________ E-mail: ______________________________________________________
For a contribution from a spouse/joint account to be attributed equally to two individuals, both must sign this form.

Contribution
q C h e c k : P l e a s e m a k e c h e c k s p a y a b l e t o J o h n C h a p m a n f o r C o n g r e s s C o m m i t t e e
- or q C r e d i t C a r d C o n t r i b u t i o n :
Please charge my contribution of $________________________ to my credit card. qVisa

qMastercard

qAmerican Express

qDiscover

Card Number:___________________________________________________________ Exp. Date: _______________ CVV: _____________________

Billing Address (if different than above): ____________________________________________________________________________________________
Signature(s):_______________________________________________________________________________________________________________
Mail to: John Chapman for Congress Committee, 138 Conant Street, 1st Floor, Beverly MA, 01915
Or scan & e-mail to: calcock@johnchapman2014.com

For questions regarding your contribution limits please contact Caroline Alcock at 617-538-2967
Contributions are limited to $2,600 per individual per election to the John Chapman for Congress Committee. The primary and general elections are separate
elections and an individual may contribute a combined total of up to $5,200 to the John Chapman for Congress Committee. Contributions from corporations,
labor organizations, foreign nationals, and federal government contractors are prohibited.
By signing this form the contributor confirms the following: This contribution is made by personal 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 lawfully admitted as a permanent resident; and this contribution will not be
reimbursed by another person;
Contributions to John Chapman for Congress are not deductible as charitable contributions for federal income tax purposes.
Paid for by the John Chapman for Congress Committee

Source: Sunlight Foundation's Party Time www.politicalpartytime.org. The Sunlight Foundation collects these invitations from anonymous lobbyist sources.