Apr 19, 2012 - or please fax your credit card charge to: 1.617.670.0652 ... credit card and not with a corporate or busi
Michael Fuchs
Dick and Sunny Aurelio Harry and Pamela Belafonte Karen Burstein Patricia Duff Gail Evertz Linda Fairstein Kevin Jennings Kerry Kennedy Bette Midler and Martin von Haselberg Michael Sennott Fred Wistow
Cordially invite you to attend a reception for
Elizabeth Warren Candidate for United States Senate – Massachusetts At the residence of
Michael Fuchs
130 East 12th Street, Penthouse New York, New York Thursday, April 19, 2012 6:00-7:30 P.M.
Suggested Contribution: Sponsor: $5,000 Guest: $2,500 Friend: $1,000RSVP to: Christine Marshall at 212.583.7010 or
[email protected] Contributions or gifts to Elizabeth for MA are not tax deductible.
Paid for by Elizabeth for MA
__YES, I will attend. __NO, I am unable to attend but would like to make a contribution. Enclosed is my contribution of $________for the April 19th Fuchs reception. Federal Election Law allows individuals to donate up to $5,000 per election cycle: $2,500 designated for the Primary Election and $2,500 designated for the General Election
Please make checks payable and mail to:
Elizabeth for MA c/o Paula Levine, 135 Clarendon Street #10W, Boston, MA 02116 or contribute online at: https://secure.actblue.com/contribute/page/nycapr19a or please fax your credit card charge to: 1.617.670.0652 Please charge my personal contribution to my: ____Visa ____MC ____AMEX Credit Card Number _________________________ Exp:__________ Sec. #_______ Cardholder’s name (as it appears on card) ___________________________________ Cardholder’s signature ________________________________________________ Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and name of employer of individuals whose contributions exceed $200 in an election cycle.
Name____________________________________________________________ Address__________________________________________________________ (if using a credit card, please provide the billing address)
City/State/Zip______________________________________________________ Employer________________________ Occupation_________________________ Office Phone______________________ Fax Phone__________________________ Email____________________________________________________________ YOU MUST ALSO SIGN BELOW: • • •
By signing below, I affirm that I am making this contribution with my own personal funds, I am not using funds provided by any other person or entity, and that I am a citizen or a lawfully admitted permanent resident of the United States. I am designating the first $2,500 of my contribution to the primary election and any amount in excess of that, up to $2,500, to the general election. (For credit card contributors only:) By signing below, I am affirming that I am making this contribution on my own personal credit card and not with a corporate or business credit card or a credit card issued to anyone else.
CONTRIBUTOR SIGNATURE: SECOND SIGNATURE FOR JOINT ACCOUNTS:
Contributions or gifts to Elizabeth for MA are not tax deductible.
Paid for by Elizabeth for MA
