SAVE THE DATE

YOU ARE CORDIALLY INVITED TO AN

EVENING RECEPTION
WITH

GOVERNOR MITT ROMNEY

MONDAY, NOVEMBER 21, 2011
LOCATION TBD
MINNEAPOLIS, MN
VIP RECEPTION AND PHOTO OPPORTUNITY: 5:30 P.M.
($2,500 PER PERSON / $5,000 PER COUPLE)
GENERAL RECEPTION: 6:30 P.M.
($1,000 PER PERSON / $2,000 PER COUPLE)
KINDLY RSVP TO TRISHA HAMM AT 651-777-3314
OR TRISHAHAMM@GMAIL.COM
Contributions are not tax deductible as charitable contributions for federal income tax purposes.
By law, the maximum amount an individual may contribute is $2,500 ($5,000 per couple) per election.
Federal multi-candidate PACs may contribute $5,000 per election. 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 per
election cycle. Contributions by corporations, foreign nationals (non-green card holders), labor unions, federal government
contractors, and minors under the age of 18 are prohibited.
Romney for President, Inc.
Post Office Box 149756
Boston, MA 02114-9756

Paid for by Romney for President, Inc.

www.MittRomney.com

Reception Monday, November 21, 2011

REPLY INFO
Yes, I will be attending the Nov. 21st VIP Reception and Photo Opportunity. Enclosed is my contribution of $ ______ ($2,500/person
$5,000/couple).
Yes, I will be attending the Nov. 21st General Reception. Enclosed is my contribution of $ ______ ($1,000/person - $2,000/couple).
No, I am unable attend, but enclosed is a contribution of $_______________.
Please make your check payable to: Romney for President, Inc.
Name_________________________________________________________________________________________
Address_______________________________________________________________________________________
City____________________________________State______________________Zip__________________________
Home Phone____________________________________ Work Phone___________________________________
E-mail_________________________________________________________________________________________
CONTRIBUTOR INFO
This contribution is made by check or credit card from my personal funds and is not drawn on an account maintained by an incorporated
entity. I am a U.S. citizen or permanent resident and this contribution will not be reimbursed by another person.
Signature_______________________________________________________________________
By law, the maximum amount an individual may contribute is $2,500 ($5,000 per couple) per election. For a contribution from a joint
account to be attributed to two individuals, both must sign this form, indicating agreement with the above statement.
Joint Contributor Signature_________________________________________________________
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 per election cycle. Please complete the following:
Occupation__________________________________________
Joint Contributor Occupation___________________________

Employer______________________________________
Joint Contributor Employer_______________________

CREDIT CARD REPLY

Please charge my contribution of $___________ to my credit card.
Visa

MasterCard

AMEX

Account Number________________________________________

Discover

Expiration Date__________________________

Name on Card____________________________________________________________________________________
Signature_________________________________________________________________________________________
Mail to: Romney for President, Inc. c/o Trisha Hamm, 2495 Ryan Avenue E., St. Paul, MN 55109
Fundraiser ID: ___________

Source Code: ____EMN001____

Contributions are not tax deductible as charitable contributions for federal income tax purposes. Contributions by
corporations, foreign nationals (non-green card holders), labor unions, federal government contractors, and minors under the
age of 18 are prohibited.
Paid for by Romney for President, Inc.
www.MittRomney.com