GOVERNOR

ANDREW M. CUOMO
INVITES YOU TO JOIN HIM
FOR A SPECIAL PERFORMANCE OF

At The Palace Theatre

1564 Broadway, New York City
Tuesday, June 14, 2011
Pre-Show/Host Committee Dinner 5:30pm
Curtain 7:00pm

For tickets and more information see enclosed response

card or visit www.andrewcuomo.com/broadway
 Response Form – Andrew Cuomo 2014
___Yes, I want to join the Governor for Dinner and a Show!

___ Chair: Raise/Contribute $25,000 (Couple) / $15,000 (Individual) – VIP seating at a pre-show/ Host Committee dinner with the
Governor, best seats in the theatre for the show and post-show reception with the cast
___ Co-Chair: Raise/Contribute $15,000 (Couple) / $10,000 (Individual) – Priority seating at a pre-show/ Host Committee dinner
with the Governor, VIP orchestra tickets for the show and post-show reception with the cast
___ Vice-Chair: Raise/Contribute $10,000 (Couple) / $7,500 (Individual) – Preferred seating at a pre-show/ Host Committee dinner
with the Governor, front orchestra tickets for the show and post-show reception with the cast

___Yes, I want to join the Governor for the Show

___ Supporter: Raise/Contribute $2,500 – Orchestra seating
for the show and post-show reception with the cast
___ Guest: Raise/Contribute $250 – Mezzanine
seating for the show and post-show reception with the
cast (Limited number of seats available at this level)
___ Friend: Raise/Contribute $1,000 –
Front mezzanine and post-show reception with the cast
___ Young Professionals: Raise/Contribute $100 –
Balcony seating for the show and post-show reception
with the cast (Limited number of seats available at this level)

Each contribution must be accompanied by a completed and signed contribution form.

CREDIT CARD CONTRIBUTION

Please charge $______________ on my __________________________________credit card.

Card #: ________________________________________________________ Exp. Date: ___________

This card is: ____ Personal ____Corporate ____ Partnership ____ Other

Name of Entity/Individual billed ____________________________________________________

Credit card contributions can be faxed to: (646) 597-6195

For compliance with NYS Election Law, please provide the following information:
Name/Contributing Entity:_______________________________________________________________________________

Address:_____________________________________________________________________________________________

Employer/Occupation:__________________________________________________________________________________

To help us better communicate with you, please provide the following:

Bus.Phone___________________________________________Email:____________________________________________

Res.Phone___________________________________________Cell:______________________________________________

The account being used to make this contribution is registered to and managed by a/an:

□ Individual □ Sole Proprietorship □ PAC or Labor Union □ Candidate Committee

□ Partnership □ Corporation □ LLC □ Party Committee

Contribution limits and guidelines for Andrew Cuomo 2014: Andrew Cuomo 2014 will accept no more than $60,800 for the 2014 election cycle ($19,700 for the
primary/$41,100 for the general) from individuals, LLCs, unions, political action committees, and trade associations. Partnerships that contribute in excess of $2,500
total over the course of the cycle will be required to specifically identify the partner(s) responsible for the contribution(s), and the attributed amount will be counted
against each partner’s individual contribution limit. Total contributions from a corporation may not exceed $5,000 per calendar year aggregate to all New York state and
local candidates and committees. It is strictly prohibited to reimburse another individual’s or entity’s contribution. All contributors must be either US citizens or
permanent resident aliens (green card holders). No State agency officer or employee who serves at the pleasure of the Governor or their appointing authority or
members of State public authority or other boards appointed by the Governor may contribute to and/or fundraise for the Governor’s campaign. Contributions are not
deductible for federal income tax purposes.

By signing below, you hereby affirm that your contribution does not violate the terms specified above.

Signature Required: __________________________________________________Date: ___________________

Please make checks payable to Andrew Cuomo 2014 and mail to:
PO Box 4105, New York, NY 10163

For further information, please contact Brooke Weinstein at (212) 551-9441or brooke@andrewcuomo.com
Paid for by Andrew Cuomo 2014. Designed in-house.