PLEASE JOIN

FOR A SMALL DINNER AND DISCUSSION

TUESDAY, MARCH 29TH AT 6:00PM

AT

310 LENOX AVENUE AT WEST 125TH STREET NEW YORK, NY

PLEASE RSVP TO BRAD THOMPSON AT

THOMPSONB@DNC.ORG OR (202) 479-5171

** SPACE IS LIMITED **

Paid for by the Democratic National Committee – www.democrats.org, This communication is not authorized by any candidate or candidate’s committee.

Yes, I would like to attend the dinner on March 29th

$30,800 per person

$61,600 per couple Please note, contributions for two guests must come from two separate accounts, a joint account, or a joint credit card.

I am unable to attend, but would like to support the dinner with a contribution of $ ______

The Democratic National Committee does not accept contributions from currently registered federal lobbyists, registered foreign nationals, political action committees, or minors under the age of 16.

Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and employer of individuals whose contributions exceed $200 in a calendar year.

First & Last Name: ________________________________________________________________________________

Address: ________________________________________________________________________________________

City/State/Zip: ___________________________________________________________________________________

Employer: ______________________________________Occupation: _______________________________________

Work Phone: ___________________________________ Work Fax: ________________________________________

Home Phone: __________________________________ Email: ____________________________________________

An individual may contribute up to $30,800 per calendar year to the DNC. Contributions from the treasuries of corporations and labor organizations are prohibited. A sole proprietorship, partnership or LLC that elects partnership taxation may also contribute up to $30,800 per calendar year to the DNC.

Federal law prohibits foreign nationals, except lawfully admitted permanent residents of the U.S., from contributing to the DNC. Contributions must be made from the donor’s personal funds. By signing below, I certify that I am a U.S. citizen or legal permanent resident of the U.S. The funds I am donating are not being provided to me by another person or entity for the purpose of making this contribution.

Signature: _____________________________________ Name (Print): ____________________________________

If contributing by joint personal checking account

Second Signature: ______________________________ Second Name (Print): _____________________________

Contribute by Personal Check: Please make your contribution payable to the “White House Victory Fund” and mail with this completed form to: Contribute by Credit Card:

Visa American Express MasterCard

Card Number: ____________________________________________________________________ Exp: ___________

Name on Card: ___________________________________________________________________________________

Signature: _______________________________________________________________________________________

If contributing by joint credit card

Second Signature: _________________________________________________________________________________

Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and employer of individuals whose contributions exceed $200 in a calendar year.

Contributions or gifts to the Democratic National Committee are not tax deductible as charitable contributions for Federal income tax purposes. The Democratic National Committee does not accept contributions from currently registered federal lobbyists, registered foreign agents, political action committees, or minors under the age of 16. Corporate and Union contributions are prohibited.

NY358 Paid for by the Democratic National Committee – www.democrats.org,

This communication is not authorized by any candidate or candidate’s committee.

White House Victory Fund Attn. Brad Thompson

430 South Capitol Street, SE, 3rd Floor Washington, DC 20003

Or fax this form to (202) 572-7854

For questions, please contact Brad Thompson at (202) 479-5171 or ThompsonB@dnc.org