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: becky@bandfllc.com 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: ____________________________
CREDIT CARD CONTRIBUTION INFORMATION
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.
