DS9 Document EFTA00292723

C O N G R E S S Please join Pamela Church • Julie Muraco Claire Silberman • Rosina Rubin Hon. Elizabeth Holtzman • Mike Klein Marcia Sudolsky • Betty Cotton Barbro Ehnbom • Judi Allen Jane Lisman Katz Tri State Maxed-Out Women Inc. Host Committee in Formation For a reception with Congresswoman Diana DeGette Chief Deputy Whip Co-Chair Pro-Choice Caucus Vice-Chair of the Congressional LGBT Caucus on Thursday, April 24th, 2014 6:30 P.M. - 8:00 P.M. at The Home of Pamela Church 300 Central Park West New York, NY10024 Contribution Levels Chair - $2,500 • Host - $1,000 Supporter - $500 • Friend - $250 To RSVP, please contact Emma Lowe a or Authorized by Diana DeGette for Congress. Inc. EFTA00292723 iiipaguk C O N G R E S S Thank you for your Support! I would like to attend the event as a Chair and contribute $2,500. I would like to be listed as an event Chair: _Yes No I would like to attend the event as a Host and contribute $1,000. I would like to be listed as an event Co-Host Yes No I would like to attend the event as a Supporter and contribute $500. I would like to attend the event as a Friend and contribute $250. I am unable to attend but would like to contribute $ Name: Address: City, State Zip: Phone number: Email: Occupation: Employer: Please make checks payable to: Diana DeGette for Congress PO Box 61337 Denver, CO 80206 Contributions can be made online: Please bill my personal credit card: 0 Visa 0 MasterCard 0 AMEX 0 Discover Amount: S Card Number: Expiration: Security Code: (for American Express only): Name as it appears on the card: Signature: Maximum contribution $5,200 per person — $2,600 Primary Election, $2,600 General Election By signing above, you authorize us to charge your card in the amount indicated. You also affirm that your contribution is made from personal funds and not from funds otherwise prohibited by law. Under federal law, an individual may give up to $2,600 per election (primary and general) for a total of $5,200 to a federal candidate and no more than $48,600 during a two- year cycle to all federal candidates. Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and employer of individuals whose contributions exceed $200 in an election cycle. Authorized by Diana DeGette for Congress, Inc. EFTA00292724