TIM AND CHRISTIE GANNON

CORDIALLY INVITE YOU TO ATTEND A RECEPTION HONORING

ADAM HASNER
CANDIDATE FOR THE U.S. HOUSE OF REPRESENTATIVES
FORMER FLORIDA HOUSE MAJORITY LEADER
AT THEIR HOME

1300 NORTH OCEAN BOULEVARD
PALM BEACH, FL 33480

TUESDAY, MAY 22, 2012
5:30PM - 7:30PM
$1,000 SUGGESTED MINIMUM PERSONAL CONTRIBUTION
$5,000 MAXIMUM CONTRIBUTION PER PERSON

REPLY FORM ATTACHED

FOR ADDITIONAL INFORMATION & TO RSVP, PLEASE CONTACT
CHRISTINA SCHERER AT 561-961-9799 OR CHRISTINA@ADAMHASNER.COM
Paid for by Adam Hasner for US House
Contributions are not deductible as charitable contributions for federal income tax purposes.

Yes! Adam can count on me/us participating at the following level:
I/We will attend the reception - $1,000 suggested contribution. Number attending: __________.
I/We are unable to attend, however enclosed is my/our contribution in the amount of $_________.

Please make check(s) payable to:

“Adam Hasner for US House”
P.O. Box 276093
Boca Raton, FL 33427-6093
Contact: Christina Scherer (561) 961-9799
Secure Fax Line: 321-697-7092
christina@adamhasner.com
www.adamhasner.com

Federal law requires that Adam Hasner for US House use its best efforts to collect and report the name, mailing address,
occupation and employer name of all contributors who donate more than $200 in an election cycle. Please provide the following
information:
CONTRIBUTOR INFORMATION

Name: Prefix: _______ First: ____________________ Middle: _________ Last: ___________________________________
Address:___________________________________________________________ Home Phone: _______________________
City:_________________________________ State:________ Zip:___________

Work Phone: _______________________

Employer: _______________________________________ Amount: ___________ Cell Phone: ______________________
Occupation:________________________________________

Email:____________________________________________

Assistant’s Name and Contact Information: ___________________________________________________________________
This contribution to Adam Hasner for US House made by check or credit card represents my/our personal funds and is not drawn
on an account maintained by an incorporated entity.
Signature: _______________________________________________________ Date: ___________
CREDIT CARD CONTRIBUTIONS

Credit Card: (circle one)

VISA

MasterCard

American Express

Discover

Card Number:__________________________________________________________________________________________
Amount: $_____________________ Expiration Date: ________________________________ CSC: ____________________
Cardholder Name:__________________________________ Signature:______________________________ Date: ________
The maximum an individual may contribute is $5,000 ($2,500 Primary, $2,500 General) ($10,000 per couple). Adam Hasner for
US House cannot accept corporate checks or contributions from foreign nationals who lack permanent resident status, or from
federal contractors or labor unions.
Event Code: ____E 05.22.12___ Sponsor/Host NAME/ID: ____Gannon___

Paid for by Adam Hasner for US House
Contributions are not deductible as charitable contributions for federal income tax purposes.

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