PETER PICKNELLY

TONY RAVOSA

ANDY YEE

Invite you to an Oktoberfest cocktail reception and private dinner

With special guest
________________________________

Governor
CHARLIE BAKER
_________________________________

W EDNESDAY , S EPTEMBER 30, 2015

T HE S TUDENT P RINCE & T HE F ORT
8 Fort Street
Springfield, Massachusetts

5:00 P . M .

C O C KT A I L R E C E PT I O N
S PO N S O R L E V E L | $500 per person

6:00 P . M .

C O C KT A I L R E C E PT I O N & P R I V A T E D I N N E R
P A T R O N L E V E L | $1,000 per person
*Private Dinner is limited to 25 guests

Ma x imu m d o n a t io n p e r ca l en d a r y ea r to th e Ba ker Co m mi tte e i s:

$ 1 ,0 0 0 p e r p e r so n / $ 2 , 0 0 0 p er co u p l e

R.S.V.P. Sarah Hunt | sh@massgop.com | (617) 523-5005

Paid for by The Baker Committee & The Polito Committee
www.charliebakerma.com | www.karynpolito.com

YES, I/we want to help Charlie & Karyn sustain victory and will ____ will not ____ attend the event on September 30, 2015.
q $____________ to The Baker Committee (maximum donation: $1,000 per person/$2,000 per couple)
and/or q $____________ to The Polito Committee (maximum donation: $1,000 per person/$2,000 per couple)

CONTRIBUTOR INFORMATION

NAME ____________________________________________________SIGNATURE ________________________________________________

OCCUPATION (required) ___________________________________ EMPLOYER (required) ________________________________________
ADDRESS _________________________________________________CITY, ST, ZIP _______________________________________________
PHONE Office Cell Home __________________________________ EMAIL ________________________________________________
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 U.S. citizen or permanent resident and this contribution will not be reimbursed by another person.

JOINT CONTRIBUTOR (SPOUSE) INFORMATION

For a contribution from a joint account to be attributed equally to two individuals, both must sign this form.
NAME ____________________________________________________SIGNATURE ________________________________________________
OCCUPATION (required) ___________________________________ EMPLOYER (required) ________________________________________
PHONE Office Cell Home __________________________________ EMAIL ________________________________________________

CONTRIBUTION SELECT ONE

q

ONLINE: The Baker Committee: https://charliebaker.ichooseapex.com/charlie-baker?EVI=EMA1124&FRI=4125

The Polito Committee: https://karynpolito.ichooseapex.com/karyn-polito?EVI=EMA1124&FRI=4125

CHECKS: Please make separate checks payable to The Baker Committee and/or The Polito Committee

CREDIT CARD: Please charge my contribution of $_____________ to my credit card.

MasterCard

Visa

Discover

American Express

Credit Card #: ___________________________________________________ Exp. Date: ____________ CVV: _______

Billing Address (if different than above): _______________________________________________________________
Authorized Signature (same as name on the card): ______________________________________________________

RETURN: Please mail to: Sarah Hunt, The Baker/Polito Committee, 85 Merrimac St., Suite 400 Boston, MA 02114
Or scan & e-mail to: sh@massgop.com
Event Code: EMA1124

Fundraiser ID: 4125

Contributions to The Baker Committee and The Polito Committee are not deductible as charitable contributions for federal income tax purposes. An
individual may contribute up to $1,000 per calendar year each to The Baker Committee and The Polito Committee. Contributions from corporations, labor
organizations, other business entities (LLCs and partnerships), out-of-state PACs, and foreign nationals are prohibited. Contributions must be made from
personal funds and may not be reimbursed by any other person or entity.

Paid for by The Baker Committee & The Polito Committee

www.charliebakerma.com | www.karynpolito.com

Contribution Form
Enclosed is my/our contribution of: $______________
Donations of up to $43,400 per person or $20,000 per Multicandidate PAC may be accepted on this form.

Contributor Information

Name: ________________________________________________________Signature____________________________________________________
Address: __________________________________________________________________________________________________________________
City, State, Zip: ____________________________________________________________________________________________________________
Phone: qOffice qCell qHome___________________________________ E-mail: ______________________________________________________
Federal law requires the Massachusetts Victory Committee to obtain and report the name, mailing address, occupation and employer for each individual whose contribution exceeds $200
in a calendar year
Occupation (required)______________________________________Employer (required)_____________________________________________

Spouse/Joint Contributor Information (if applicable) Spouse/Joint Donations up to $ 8 6 , 8 0 0

per couple can be accepted on this form

Joint Contributor Name_________________________________________Signature_____________________________________________________

Occupation (required)___________________________________________Employer (required)_________________________________________
Phone: qOffice qCell qHome___________________________________ E-mail: ______________________________________________________
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 U.S. Citizen or permanent
resident and this contribution will not be reimbursed by another person. For a contribution from a spouse/joint account to be attributed equally to two individuals, both must sign this form,
indicating agreement with the above statement.

Contribution
q O n l i n e : https://mavictory.ichooseapex.com/donate?EVI=EMA1124&FRI=4125
- Or q C h e c k : P l e a s e m a k e c h e c k s p a y a b l e t o M a s s V i c t o r y
- Or q C r e d i t C a r d C o n t r i b u t i o n :

Please charge my contribution of $_____________to my credit card. qVisa

qMasterCard

qAmerican Express

qDiscover

Card Number: __________________________________________________________________ Exp. Date: __________ CVV: ________

Billing Address (if different than above): __________________________________________________________________________________
Signature(s):_____________________________________________________________________________________________________
Mail to: Massachusetts Victory Committee, c/o David Drummond, 85 Merrimac Street, Suite 400, Boston, MA 02114
Or e-mail to: ddrummond@massvictory.com

Contributions to Massachusetts Victory Committee are not tax deductible for federal income purposes. Massachusetts Victory Committee is a joint fundraising committee
composed of the Massachusetts Republican Party and the Republican National Committee. Proceeds shall be allocated by the following formula: 1. Individuals and NonMulticandidate PACs: The first $10,000 shall go to the Massachusetts Republican Party- Federal Account. The next $33,400 shall go to the Republican National Committee. 2.
Multicandidate PACs: The first $5,000 shall go to the Massachusetts Republican Party- Federal Account. The next $15,000 shall go to the Republican National Committee. The
allocation formula may change if any contribution would exceed applicable contribution limits; however, no part of any contribution made pursuant to this Notice will be
allocated to any Committee not identified in the above formula. All contributions permissible under the FECA but that would cause a contributor to exceed any applicable
Federal contribution limit to a specific committee, shall be reallocated to the remaining committee to the extent permitted to the FECA according to this formula. Any
contribution that would otherwise cause a contributor to exceed Federal contribution limit or not be permissible under the FECA shall be refunded to the contributor. All funds
received in response to this solicitation will be subject to federal contribution limits and prohibitions. Contributions from corporations, labor unions, federal contractors, and
foreign nationals are prohibited. The maximum an individual can contribute to this joint fundraising committee is $43,400 per year.

Paid for by the Massachusetts Victory Committee, a joint fundraising committee composed of the Massachusetts Republican
Party and Republican National Committee. Not authorized by any candidate or candidates committee.
310 First Street, SE Washington D.C. 20003