Host

THE HONORABLE JACK FIELDS

and

Norm Lent, Jr. Request the pleasure of your company For a Reception With

U.S. Senator Marco Rubio

Benefiting Reclaim America PAC The Leadership PAC Sponsored by Marco Rubio to support Conservative Candidates

Wednesday, July 11, 2012 6:30 PM 7:30 PM 434 New Jersey Avenue, SE Washington, DC 20003 Host: $2,500 General: $1,000 PAC / $500 Personal To RSVP please contact Carmen Spence at (703) 517-9210 or email at carmen@millerspence.com
Paid for by Reclaim America PAC. Not authorized by any candidate or candidate's committee. www.ReclaimAmericaPAC.COM
Source: Sunlight Foundation's Party Time www.politicalpartytime.org. The Sunlight Foundation collects these invitations from anonymous lobbyist sources.

J U LY 11 TH R EC EPTIO N FO R R EC LA IM A M ERIC A PAC A C C EPTA N C E F O RM

Please make check(s) payable to:
Reclaim America PAC ATTN: Carmen Spence P.O. Box 7557, Arlington, VA 22207 Phone: (703) 517-9210 or Fax to (703) 997-5841
ACCEPTANCE FORM

_____ Yes, I/we would like to be a HOST (Raise / Contribute $2,500) for the July 11th Reception with Senator Rubio. Enclosed is my/our contribution in the amount of $_________ for _______ HOST ticket(s) to the fundraiser. _____ Yes, I/we would like to attend for the July 11th Reception with Senator Rubio. Enclosed is my/our contribution in the amount of $_________ for _______ ticket(s) to the fundraiser ($1,000 PAC / $500 Personal). _____ No, I/we will be unable to attend, but have enclosed $____________ to help Reclaim America.
Please indicate below the name(s) of the guest(s) attending the reception: 1. _________________________ 2.________________________ 3._________________________ 4. ______________________ Federal law requires us to obtain and report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $200 in a calendar year.
CONTRIBUTOR INFORMATION

Name: Prefix: _______ First: ____________________ Middle:_________ Last: ____________________________________ Address:___________________________________________________________ Home Phone: ________________________ City:_________________________________ State:________ Zip:___________ Employer: _______________________________________ Occupation:________________________________________ Work Phone: _______________________ Cell Phone: _________________________ Email:____________________________________________

Assistants Name and Contact Information: ___________________________________________________________________ This contribution to Reclaim America PAC made by check or credit card represents my/our personal funds and is not drawn on an account maintained by an incorporated entity. SIGNATURE: _______________________________________________________

CREDIT CARD CONTRIBUTIONS

Credit Card: (circle one)

VISA

MasterCard

American Express

Discover

Card Number:__________________________________________________________________________________________ Amount: $________________________________________ Expiration Date:______________ Sec. Code________________ Cardholder Name:__________________________________ Signature:____________________________________________ Contributions to Reclaim America PAC are not tax deductible for federal income tax purposes. Contributions by corporations, foreign nationals (non green-card holders), and federal government contractors are prohibited. By law, the maximum amount an individual may contribute to Reclaim America PAC is $5,000 ($10,000 per couple) per calendar year. Qualified PACs may contribute $5,000 per calendar year. Non-qualified PACs may contribute $2,500 per election. Event Code: LPAC007-12 Sponsor/Host NAME/ID: _____________________

Paid for by Reclaim America PAC. Not authorized by any candidate or candidate's committee. www.ReclaimAmericaPAC.COM

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