Please join

Senator John D. Rockefeller IV

at a Reception Honoring
Governor Joe Manchin III (D-WV)
Candidate for US Senate
Tuesday, August 3, 2010
6:30 – 8:00 pm
at the home of
Jay and Sharon Rockefeller
Address to be given out upon RSVP
Washington, D.C.
$5,000 – Host $2,500 – Sponsor
$1,000 PAC or Individual
Contributions should be made payable to:

“Manchin for West Virginia”

426 C Street, NE
Washington, DC 20002

**RSVP to Jeremy S. Gold to ensure security listing**

(202) 546-9292 or jeremysgold@yahoo.com

Contributions to Manchin for West Virginia are not deductible as charitable contributions for federal
income tax purposes. Corporate contributions are prohibited. Contributions from foreign nationals
are not permitted. Federal law requires us to use our best efforts to collect and report the name,
mailing address, occupation and name of employer for each individual whose contributions exceed
$200 in election cycle. Not printed at government expense.

Paid for and authorized by Manchin for West Virginia

Reception at home of Senator Rockefeller to benefit Manchin for West Virginia

___ Yes, I would like to attend with a $________ contribution.

___ Sorry, I am unable to attend the event, but enclosed is my contribution of $___________.

Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and name of
employer of individuals who make contributions.

Corporate contributions, contributions from individuals under the age of 18, and contributions from non-U.S. citizens who
are not lawfully admitted for permanent residence are prohibited.
All contributions by individuals must be made from personal funds and may not be reimbursed or paid by any other
person.

Name_________________________________________________________

Organization___________________________________________________

Title__________________________________________________________

Address_______________________________________________________

City, State, ZIP__________________________________________________

Phone________________________ Fax______________________________

Email_________________________________________________________

Guest(s)_______________________________________________________

Make checks payable to

“Manchin for West Virginia” and mail to:
426 C Street, NE
Washington, DC 20002

OR FAX THIS FORM TO: Attn: Jeremy Gold at (202) 543-8455

Please bill $______ to my: ___Visa ___ Mastercard ___ AMEX

Account # ____________________________Exp.____________

Signature____________________________________________

This personal, not corporate, card belongs to__________________

Contributions to Manchin for West Virginia are not deductible

for federal income tax purposes.

Paid for and authorized by Manchin for West Virginia