Ken Cuccinelli

Attorney General (VA)

Republican Candidate for Governor
Wednesday, June 13, 2012
6:30 PM
Tower Club, Tysons Corner
8000 Towers Crescent Drive, 17th Floor
Tysons Corner, VA 22182
[ ] Yes, I would like to attend the reception for Ken Cuccinelli. Please make reservations as follows:
___ $25,000 Host
___ $10,000 Co-Host
___ $5,000 Benefactor
___ $2,500 Sponsor
___ $1,000 Patron
___ $250
Friend
___ Please make ____ reservations at $50 per person
[ ] No, I will not be able to attend the reception but would like to contribute $ _______
Please make checks payable to: Ken Cuccinelli for Governor and mail to:
123 N Pitt Street, Suite 500, Alexandria, VA 22314
or fax to (877) 418-6444
Name:___________________________________________________________
Address: _________________________________________________________
City/State/Zip: ____________________________________________________
Phone:___________________________________________________________
Cell:_____________________________________________________________
Fax:_____________________________________________________________
Occupation/Employer*:______________________________________________
Employer Location*:_________________________________________________
If you wish to donate by credit card, please complete below:
Please charge my contribution of $___________________
to my: [ ] Visa [ ] Mastercard [ ] AMEX
Card Number ________________________________ Exp. Date_______
Security Code (3 digit number on back or 4 digit number on front of Amex):____________
Signature:______________________________________________________________
All funds solicited in connection with this event are by Cuccinelli for Governor and not by any federal office holder
or candidate for federal office. Political contributions are not tax deductible for federal income tax purposes. State
law requires us to report occupation and employer information for individuals who give more than $100 aggregate.
Paid for and authorized by Cuccinelli for Governor

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