07 23 12 jax event invite 3 (5)
TRANSCRIPT
� This contribution to Friends of Connie Mack represents my personal funds and is not drawn on an account maintained by an incorporated entity.
� Yes, I/We will attend the reception. Please reserve _____ ticket(s) at $500 per person ☐ Yes, I/We will contribute the maximum to Friends of Connie Mack. ($5,000 per person/ $10,000 per couple) ☐ I/We cannot attend the event, but would like to contribute $____________________. ☐ Please charge $____________ to my: ☐ Visa ☐ MasterCard ☐ Amex ☐ Discover Card Number: _______________________________ Exp: ________________ 3 or 4-digit Security Code: ______________ Name as it appears on card if different from below: ____________________________________________________________ Billing Address: ________________________________________________________________________________________________
Please make checks payable to: "Friends of Connie Mack"
mail to: PO Box 14-1129, Coral Gables, FL 33114 or fax to: (850) 270-6908 **may also contribute via www.conniemack.com
Individuals may contribute up to $2,500 to the primary election and $2,500 to the general election. PACs may contribute up to $5,000 to the primary election and $5,000 to the general election. Political contributions are not deductible as charitable contributions for the purposes of federal income tax. Federal law requires political committees to report the name, mailing address, occupation and name of employer of individuals
whose contributions exceed $200 per election cycle. Contributions from foreign nationals are prohibited. No corporate checks or corporate credit cards may be accepted.
________________________________________________________________________________________________________________________ Your Name Spouse’s Name ________________________________________________________________________________________________________________________ Address City State Zip ________________________________________________________________________________________________________________________ Home Phone Office Phone Fax Email Address ________________________________________________________________________________________________________________________ Employer Occupation ________________________________________________________________________________________________________________________ Spouse Employer (if joint contribution) Spouse Occupation (if joint contribution) ________________________________________________________________________________________________________________________ Signature Spouse Signature (if joint contribution)
Event Code: E120723
HOST COMMITTEE
DR. JAVIER GARCIA-BENGOCHEA RICHARD BROWDY
ED BURR GARY & NANCY CHARTRAND
MARTY FIORENTINO JOE MOBLEY
DICK MORALES FITZHUGH K. POWELL DR. SHYAM PARYANI
TOM PETWAY AMBASSADOR JOHN ROOD
KENT & CHRISTIE STERMON CHRIS VERLANDER
(HOST COMMITTEE IN FORMATION)
CORDIALLY INVITE YOU TO A FUNDRAISING RECEPTION IN SUPPORT OF
CONGRESSMAN CONNIE MACK FLORIDA'S NEXT UNITED STATES SENATOR
MONDAY, JULY 23, 2012 5:00 P.M. – 6:30 P.M.
AT THE HOME OF MATT & SHANNON CONNELL
2817 FOREST CIRCLE � JACKSONVILLE, FLORIDA
MINIMUM SUGGESTED CONTRIBUTION $500 PER PERSON
RSVP TO CHERYL SEINFELD AT 305-456-2389 OR [email protected]
Paid for by Friends of Connie Mack, Inc.