The Upstate New York Tea Party

cordially invites you to join
U.S. Senate Candidate Wendy Long
on Saturday, September 8th,
at the Plattsburgh Comfort Inn
(411 Route 3)
from 5:00 to 7:00 PM
A cash bar and h’orderves will be provided.
$25.00 per person/$40.00 per couple

For more information or to RSVP please contact:
Mark L. Barie - unytea@yahoo.com or 800-545-8125

PAID FOR BY WENDY LONG FOR NEW YORK, INC.

_____ Yes I will join Wendy, UNYTEA, and the GOP, on September 8th
_____ No, I cannot join Wendy, UNYTEA, and the GOP, on September 8th, but
please accept my generous donation
$10,000 (Maximum Contribution for Primary and General Election Funds (per couple)
$5,000 (Maximum Contribution for Primary and General Election Funds
$2,500

$1,000

$500
$250
$100
$ Other: ___________
Please Make Checks(s) Payable to:
Wendy Long for New York, Inc.
P.O. Box 4491, New York, NY 10163

Federal law requires us to obtain and report the name, mailing address, occupation and name of employer for each
individual whose contribution aggregate in excess of $200 in an election cycle. By submitting your contribution, you agree
that the first $2,500 is designated for the primary, and any additional amount up to $2,500 is designated for the general
election.

Name: Prefix: _____ First: __________________ Middle: _____ Last: __________________
Address: _______________________________________________________________ _
City: __________________________________ State: _______ Zip: __________________
Home #: _________________ Cell #: __________________ Work #: _________________
Email: __________________________________________________________________
Employer: _______________________________________________________________
My signature below attests that this contribution is made by check or credit card from my personal funds and is not
drawn on an account maintained by an incorporated entity. I am a US Citizen or permanent resident and this contribution
from a joint account to be attributed equally to two individuals, both individuals must sign this form.

Signature: ___________________________________
Spouse Contribution Information for Joint Contribution
Name: Prefix: _____ First: __________________ Middle: _____ Last: __________________
Address: _______________________________________________________________ _
City: __________________________________ State: _______ Zip: __________________
Home #: _________________ Cell #: __________________ Work #: _________________
Email: __________________________________________________________________
Employer: _______________________________________________________________
Signature: ___________________________________
Visa

American Express
Discover
MasterCard
Cardholder Name: ___________________________________________________________
Cardholder Number:

______________________________________ Expiration Date: __________

Security Code (3 digit code on back of card or 4 digit code on front of AMEX)

__________ Amount: $ _______________

Contributions to Wendy Long for New York, Inc. are not tax deductible as charitable contributions for federal income tax purposes. Federal law requires us to
obtain and report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $200 in an
election cycle. We may accept contributions from individuals of $5,000 ($2,500 for the primary and $2,500 for the general election). A couple contributing from a
joint account may contribute $10,000 ($5,000 for the primary, $5,000 for the general). A multi-candidate federal PAC may contribute $10,000 ($5,000 for the
primary and $5,000 for the general). Contributions from corporations, labor organizations, federal government contractors, and foreign nationals without
permanent resident status are prohibited.

PAID FOR BY WENDY LONG FOR NEW YORK, INC.

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