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07 23 12 Jax Event Invite 3 (5)

07 23 12 Jax Event Invite 3 (5)

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Published by Matt Dixon

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Published by: Matt Dixon on Jul 24, 2012
Copyright:Attribution Non-commercial

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07/24/2012

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  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 CHERYL@CONNIEMACK.COM
Paid for by Friends of Connie Mack, Inc.

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