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Chitranjan S.

Ranawat, MD & The Political Action Committee of the American Association of Orthopedic Surgeons
along with

Anil Ranawat, MD Frank A. Cordasco, MD Scot B. Glasberg, MD Daniel W. Green, MD Joseph Bosco, MD Invite You to a Cocktail Reception
with

Nan Hayworth, MD
Congresswoman (NY-19th)
Committee on Financial Services Republican Israel Caucus, Doctors Caucus & Congressional Caucus for Women’s Issues

Monday, July 2, 2012 6:30 p.m. – 8:00 p.m. The Union Club 101 East 69th Street New York City
R.S.V.P. Required Online: Please Click Here By Email: GreenDW@hss.edu By Hand: Mail or Fax Attached Form to 212-922-0971
Contributions to the Friends of Nan Hayworth Campaign are not tax deductible as charitable contributions. Contributions from corporations, foreign nationals without green cards and federal government contractors are prohibited. Funds received in response to this solicitation are subject to federal contribution limits. Federal Election Law requires the campaign to use its best efforts to obtain and report the name, address, occupation, and employer for each individual whose contributions aggregate over $200 in an election cycle. Not printed at government expense. Paid for by Friends of Nan Hayworth C00466490
Source: Sunlight Foundation's Party Time www.politicalpartytime.org. The Sunlight Foundation collects these invitations from anonymous lobbyist sources.

Congresswoman Hayworth, I am proud and honored to join you on July 2, 2012 to support your reelection campaign. I am enclosing my most generous contribution in the amount of:
 $250 Please reserve ________ ticket(s)  $500 Please reserve ________ Co-Host ticket(s)  $1,000 Please reserve ________ Vice-Chair ticket(s)
 I fully support Congresswoman Nan Hayworth for Congress by maxing out to her campaign at the

$2,500 level.

 I will attend the Reception

 I am unable to attend the Reception

Name of Guest(s):1._____________________________2.________________________ Unfortunately, I am unable to participate but am enclosing a contribution in the amount of:
 $5,000  $2,500  $1,000  $500  $250  $________ other

Please make checks payable to: Friends of Nan Hayworth and send to: Friends of Nan Hayworth 200 Park Avenue, 26th floor/Dilen Suite, New York, NY 10166 Phone: (212) 867-3393 Fax: (212) 922-0971 Email: NanHayworthNY@gmail.com To contribute by personal credit card, please complete the following: Amount: $__________

Name on card: __________________________________________________________ Card #: ______________________________ Security Code: ________ Exp. Date: _____

My signature verifies that this contribution represents my personal funds and is not drawn on an account maintained by an incorporated entity or other prohibited source.

Signature of Contributor: _________________________________________________
Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and name of employer of individuals whose contributions exceed $200 in a calendar year. Corporate and foreign national contributions are not permitted. Contributions are not deductible for income tax purposes

Full Name: ____________________________________________________________________________ Spouse’s Name (if joint):______________________________ Spouse’s Sig. (if joint): __________________ Employer: ________________________________________Occupation: __________________________ Spouse’s Employer (if joint): _________________________Spouse’s Occupation (if joint): _____________ Address:______________________________________________________City:____________________ State: ____________________________________________Zip: ________________________________ Fax: ____________________ Home Phone: _____________________Work Phone: ________________ Email: ___________________________________________________Mobile Phone: ________________

Paid for by Friends of Nan Hayworth _
Not printed at Government Expense

Source: Sunlight Foundation's Party Time www.politicalpartytime.org. The Sunlight Foundation collects these invitations from anonymous lobbyist sources.