Please join
John Luisi
for a post-holiday reception in support of
New York City Public Advocate
Bill de Blasio
Wednesday, January 9, 2013
7:45PM – 9:30PM
203 Saint Paul’s Avenue
(corner of Clinton Street)
Staten Island, 10304
Suggested Donation:
Students, Retirees, and NFPs: $25
Bill’s Boosters: $50
the Advocate’s Advocates: $175
Contributions of any amount are greatly appreciated
All donations made by New York City residents up to $175 will be matched six times by the New York City Matching Funds Program
(e.g. a $100 donation + $600 matching funds = $700 for Bill’s campaign)
To RSVP (not required, but nice), please contact:
John Luisi
johnvluisi@gmail.com / 718.442.3377
or Elana Leopold
elanadleopold@gmail.com / 646.361.2530
New Yorkers for De Blasio • Wednesday, January 9th
___ Yes, I will attend and shake Bill’s hand!
_____ Sorry, I cannot attend but would like to support Bill with a contribution to New Yorkers for De Blasio
Name: _________________________________ Home Address: ________________________________________
City: _________________ State: _________ Zip: ____________
Your Employer’s Name: ___________________________ Your Occupation: ______________________________
Your Work Address: ___________________________ City: _______________ State: _________ Zip: __________
Phone (optional): ______________________ (Cell ___ Home ___ Work___ )
E-mail address: ___________________________________ (Get campaign updates!)
Contribution Amount: $ __________
Please indicate if contribution is being made by:
Personal Check (payable to New Yorkers for De Blasio) ________
Cash ($100 or under) ________ Money Order ($100 or under) ________
If credit card, please charge my: ____ Visa ____ MasterCard ____ AMEX
Credit Card No.: ______________________________________ Exp. Date: ______________
The following statement is required by NYC Campaign Finance Board Rules:
I understand that State law requires that a contribution be in my name and be from my own funds. I hereby affirm that this contribution is being made from my personal funds, is not being reimbursed in any manner, and is not being made as a loan.
Credit Card Contributors: I affirm that this contribution is being made from my personal credit card account, billed to and paid by me for my personal use and having no corporate and business affiliation, and is not being made as a loan.
Your signature required: _____________________________ Date signed: ________________
If unable to attend and want to make a contribution online, visit: www.newyorkersfordeblasio.com/contribute
or mail checks or money orders to
New Yorkers for De Blasio
30 Broad St, Suite 1439
New York, NY 10004
**Contributions from NYC residents up to $175 will be matched 6 to 1 by the NYC Campaign Finance Board**
The maximum contribution for an individual to the campaign is $4,950.
*For contributions of more than $400 only: Please complete a "Doing Business" questionnaire (available upon request)
Contribution Requirements:
- We cannot accept: contributions from corporations, partnerships or limited liability companies (LLCs); cash contributions that are more than $100; any contributions over $4,950. *If a contributor has business dealings with the City as defined in the Campaign Finance Act, the contribution limit is $400. Federal law prohibits contributions from foreign nationals. We cannot accept contributions from political committees, unless the committee registers with the Campaign Finance Board. If you wish to make a contribution from an unregistered committee, call Ellyn Canfield at (541) 760-2637 for a registration form. Contributions are not tax deductible.
State law prohibits making a contribution in someone else’s name, reimbursing someone for a contribution made in your name, being reimbursed for a contribution made in your name, or claiming to have made a contribution when a loan is made.