PLEASE JOIN
POLLY CLEVELAND & TOM HAINES
& TRUDY L. MASON
FOR
"EAST MEETS WEST"
AN EVENING WITH
CONGRESSWOMAN CAROLYN B. MALONEY
RANKING MEMBER, SUB-COMMITEE ON FINANCIAL INSTITUTIONS & CONSUMER CREDIT
MEMBER, COMMITTEE ON OVERSIGHT & GOVERNMENT REFORM
MEMBER, FINANCIAL SERVICES COMMITTEE
MEMBER, JOINT ECONOMIC COMMITTEE
FEBRUARY 22ND
6:00 - 8:30 PM
CLEVELAND/HAINES RESIDENCE
[ADDRESS WITHHELD]
SPONSOR - $2500 PATRON - $1000
SUPPORTER - $500 GUEST - $250
YOUNG PROFESSIONAL/STUDENT - $100
SENIOR - $100
To RSVP or more information please contact:
Jacob Tugendrajch at (212) 987-5516 or Jacob@Carolynmaloney.com
To purchase tickets or contribute online go to Carolyn's Website
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Join us on Wednesday, February 22, 2012 for a reception in support of
Congresswoman Carolyn Maloney
6:00 to 8:00 pm at the Cleveland/Haines Residence, NY, NY
YES, I would like to participate as a:
___Sponsor - $2500*
___Patron - $1000*
___Supporter - $500*
___Guest - $250*
___Young Professionals/Students - $100*
___Seniors - $100*
*Subject to Federal Campaign Finance contribution limits.
Make a Contribution/ Attend the Event
£ I/we will attend the February 22nd Reception. Enclosed is my contribution of:
£$2,500 £$1,000 £$500 £$250 £$100 £Other: $__________ For __________ Tickets
Name(s) of attendee(s): __________________________________________________________________
£ I/we cannot attend, but have enclosed my/our contribution of $_______________.
Contributor Information (The following information is required by Federal campaign finance law.):
Name: _________________________________________________________________________________
Home Address: __________________________________________________________________________
City: _______________________________________________ State: __________ Zip Code: ___________
Employer's Name: ________________________________Occupation: _______________________________
Please provide the following information so we can contact you, if necessary.
This information is for internal purposes only and will not appear in required public disclosure filings:
Tel. No. (W): ________________________ Tel. No. (Home or Cell): _____________________________
Fax number: ________________________ E-mail address: _______________________________________
Please indicate if contribution is being made by: £ Cash £ Check £ Money Order £ Credit Card
Credit Card Contributions: Please Charge $__________ on my £ Visa £ MasterCard £ AMEX £ Discover
Card Number: ________________________________________________________________ Exp. Date _______________/_______________
Signature: __________________________________________________________________________________________________________
To make a contribution on line please visit: Carolyn's Website . You can fax this form to 212-987-5058.
Please make checks payable to Maloney for Congress and send to
Maloney for Congress, 24 East 93rd Street, Suite 1B, NY, NY 10128
Contributions to Maloney for Congress are not deductible for federal income tax purposes. Contributions and gifts to Maloney for Congress are not deductible for federal income tax purposes. Individual contributions are limited to $2,500 per federal election. The primary and general election are considered separate federal elections with each having a separate contribution limit. Thus, an individual may contribute a total of $5,000 for the 2012 elections. All contributions must be made from the contributor's personal funds. Individuals are strictly prohibited from reimbursing another person for making a contribution to Maloney for Congress. Contributions from corporations, labor organization treasury funds and foreign nationals are prohibited.
For further information, please contact Jacob Tugendrajch at 212-987-5516 or jacob@carolynmaloney.com
Paid for by Maloney for Congress. Designed in-house.