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Harvey Auerbach Clara & Tom Datre Ambassador Charles A. Gargano

Daphne & Peter Hoffman The Honorable John Jay LaValle Anthony Scaramucci

Frank A. Aprea Leonard A. Bellavia, Esq. Denis J. Connors Michael Moriarty, Esq.

Fred Romito Andrew B. Siben, Esq. Claudia & Carl Troiano John C. Tsunis, Esq.

Jo Ann Boettcher Doug Chapey Thomas D. Croci Terry Gardner, Jr.

Philip Goglas, Esq. Eric A. Kopp Diane Nicolia Bill Manger

Lou Modica Michael J. Sacca John Schettino, Esq. John C. Zaher, Esq.

Lee M. Zeldin, Esq.
***committee still in formation


The Honorable Rick Lazio
Thursday, December 3, 2009
Islandia Marriott
3635 Express Drive North
Islandia, New York 11749

6:30 P.M. Private Co-Chair’s Reception with Rick
(Contribute or raise $2,500 per person)

7:00 P.M. General Reception
(Contribute $250 per person)

Kindly RSVP to Amanda Ober at 860.930.8396
or via email at
Rick Lazio RSVP – December 3, 2009
The following information is required:
Name __________________________________________________________________________
Street Address ___________________________________________________________________
Phone: ___________________________________Fax ___________________________________
E-mail __________________________________________________________________________
Occupation: _____________________________________________________________ ‰ Retired

‰ Yes, I/we would like to serve as a Co-Chair (Contribute or Raise $2,500) and attend the private
Co-Chair’s reception with Rick.

Please list my/our name(s) as______________________Enclosed is my contribution of $________

‰ Yes, I/we would like to serve on the Host Committee (Contribute or Raise $1,000).

Please list my/our name(s) as______________________Enclosed is my contribution of $________

‰ Yes, I/we would like ____ticket(s) for the General Reception ($250 p/p).

Enclosed is my contribution of $_____________

‰ No, I am unable to attend, but I want to help. Enclosed is my contribution of $_______________
Kindly send completed form and donation to:
LAZIO 2010, Inc.
C/O: Amanda Ober
40 Central Park South, 6G
New York, NY 10019
You may also scan and email this form to:
Credit Card Contributions:

‰ Mastercard ‰ Visa ‰ American Express
Credit Card # ____________________________________________________________________
Expiration Date _______________________ Security Code________________________________

Is this a corporate card? Yes No Corporation Name _______________________________
If this is a corporate card, by law it will be considered a corporate donation.
Name as it appears on the card______________________________________________________
Billing Address (if different)
Authorized Signature
(must be same as name on the card)

Please make checks payable to:

Contributions to Lazio 2010 are limited to $52,250 per donor for the 2010 election cycle ($14,450 for
the primary and $37,800 for the general). These limits relate to contributions by individuals, LLCs,
unions, PACs, and partnerships. Any partnership contribution in excess of $2,500 must be allocated
amongst the individual partners. Corporations may donate up to $5,000 per year (in the aggregate to
all committees). Contributions to Lazio 2010 are not tax deductible, and all contributions must be from
U.S. citizens or permanent resident aliens. Source Code: (ENY006-LI/SUFFOLK)

Paid for and authorized by LAZIO 2010, Inc.