Co-Chairs

:
Hannah Banks, Shawn Fitzgibbons and Treff LaFleche
Host Committee in Formation:
Representative Ruth Balser, Ralph Bolman, Senator Cynthia Creem,
Alderman Vicki Danberg, Representative Kay Khan, Sara Kelly,
Phyllis Kirschner, Representative John Lawn, Judith and Frederick Makrauer,
Herb Robinson, Ruth Shapiro and Harmony Wu

Invite you to a reception with

First Lady Diane Patrick and
Treasurer Steve Grossman
Thursday, February 23, 2012
At the Home of Treff LaFleche
86 Prince Street
West Newton, MA
6:30 pm -- Host Reception
7:00 pm – Main Reception with Diane Patrick and Steve Grossman
For more information, please contact:
Ryan Fleury at rfleury@barackobama.com or 617-717-4655

RSVP Online:
https://my.barackobama.com/february23newtonreception?custom1=1142568
Paid for by Obama Victory Fund 2012, a joint fundraising committee authorized by Obama for America
and the Democratic National Committee.

Yes! I would like to attend the February 23rd Reception:
 $1,000 per person (Host Committee)
 $500 per person (Sponsor)
 $250 per person (General Admission)
 $44 per person (Gen 44, limited number of tickets)
If purchasing multiple tickets, please list the names of your additional ticketed guests: _____________________________
I was invited to attend by: Shawn Fitzgibbons
Please make checks payable to:

Obama Victory Fund 2012
77 Summer Street, 7th floor
Boston, MA 02111
Fax: (312-361-8066)

Total Amount: $________________
Click here to contribute online at:
https://my.barackobama.com/february23newtonreception?custom1=1142568
Obama Victory Fund 2012 does not accept contributions from currently registered federal lobbyists, registered foreign agents, political action committees, or minors under the age
of 16. Corporate and labor union contributions are prohibited.
Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and employer of individuals whose contributions exceed $200 in an
election cycle.

First & Last Name: __________________________________________________________________________________________________
Address: ______________________________________________________________________________________________________________
City/State/Zip: _________________________________________________________________________________________________________
Employer: _____________________________________________ Occupation: ____________________________________________________
Work Phone: ___________________________________________ Work Fax: _____________________________________________________
Home Phone: __________________________________________ Email: _________________________________________________________
Federal law prohibits foreign nationals, except lawfully admitted permanent residents of the U.S., from contributing to the Obama Victory Fund 2012. By signing below, I certify
that I am a U.S. citizen or lawfully admitted permanent resident of the U.S., the funds I am donating are not being provided to me by another person or entity for the purpose of
making this contribution, and that my contribution shall be allocated as stated below.

Signature:____________________________________________________________________________________________
Contribute by Personal Check:
Please make checks payable to “Obama Victory Fund 2012” and mail to the address listed above.

Contribute by Credit Card:
Please bill my personal credit card:
Card Number: _____________________________________________________________________Exp:________________________________
Name as it appears on the card: __________________________________________________________________________________________
Signature: _____________________________________________________________________________________________________________
Second Name on Account, if Joint Account*: _______________________________________________________________________________
*Contributions will be evenly attributed between names.
2nd Name Employer: ______________________________________ 2nd Name Occupation_______________________________________
Second Signature for Joint Account: ______________________________________________________________________________________

Contributions or gifts to Obama Victory Fund 2012 are not tax deductible.
Contributions to Obama Victory Fund 2012 will be allocated as follows:

The first $5,000 of a contribution to OVF 2012 will be allocated to Obama for America (with the first $2,500 designated for the primary election, and the next
$2,500 for the general). The next $30,800 of a contribution will be allocated to the Democratic National Committee. A contributor may designate a contribution
for a particular participant. This allocation formula may change if following it would result in an excessive contribution.

Paid for by Obama Victory Fund 2012, a joint fundraising committee authorized by Obama for
America and the Democratic National Committee.

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