Wednesday, July 20, 2011

Governor George Allen to be in Orange August 3rd

Doug Rogers

The Honorable Ed Scott

John D. Tucker

Cordially invite you to attend a reception in honor of

George Allen

Candidate for United States Senate

Wednesday, August 3rd

6:00pm - 7:30pm

Elmwood at Sparks

124 West Main Street

Orange, VA

Yes, I/We would like to attend the reception:

______$2,500 Benefactor -- 4 reception reservations & recognition at the event

______$1,000 Sponsor -- 2 reception reservations & recognition at the event

______$250 Friend-- 1 reservation to the reception & recognition at the event

______$35 Individual-- 1 reservation to the reception

No, I/We will not be able to attend but would like to contribute $________.

Checks should be made payable to “George Allen for U.S. Senate”

Please mail to 101 E. Cary Street, Richmond, VA 23219

RSVP to Becky Schmidt

Phone: (804) 344-8081 Email: Fax: (804) 344-0092

FIRST: _________________________________ MIDDLE INITIAL: ________________________ LAST: _______________________________________

ADDRESS: _______________________________________________________________________

CITY: _____________________________________ STATE: ________________________________ ZIP: _________________________________________

PHONE: ___________________________________ MOBILE: _______________________________WORK: _________________________

FAX: ______________________________________ EMAIL: _________________________________

OCCUPATION: ______________________________ EMPLOYER: ____________________________

SPOUSE NAME: _____________________________

SPOUSE OCCUPATION: _______________________ SPOUSE EMPLOYER: ___________________________________________

Individuals may contribute up to $2,500 per election -- $2,500 for the primary, and an additional $2,500 for the general election. Individuals may write one check for $5,000 and

indicate “primary/general” in the memo of the check. A couple may write a check drawn on a joint account (both names are listed on the account) for up to $10,000 if

“primary/general” is indicated in the memo of the check and this form is completed and signed by both contributors.

SIGNATURE: _________________________________ SIGNATURE: ____________________________


CARD NUMBER: ______________________________ NAME ON THE CARD: _______________________________

EXP DATE: ___________________________________ SECURITY CODE: ______________________ CARD TYPE: ______________________________________

BILLING ADDRESS (if different from above):____________________________________________________

Contributions to George Allen for U.S. Senate are not deductible as charitable contributions for federal income tax purposes. Corporate contributions are prohibited. Contributions

from foreign nationals are not permitted. Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and name of employer for each

individual whose contributions exceed $200 in an election cycle.

Paid for and authorized by George Allen for U.S. Senate.

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