D

Please Join
Paul Bruhn
T.J. Donovan
Cate McLachlan & Jake Perkinson
Liz Miller
Lisa Schamberg & Pat Robins
Mary Sullivan & Don Meals
Stacy & Miro Weinberger

Sarah Muyskens & Michael Green

Allyson Laackman
David Mickenberg
Karen Paul & Mark Saba
Paul Sisson
Mary & Tim Volk
Theresa Alberghini DiPalma &
Robert DiPalma

And Special Guest

Senator Cory Booker
For A Reception Supporting The Re-Election Of

Senator Patrick Leahy

Monday, May 2nd, 2016
5:30 7:00 pm
Home of Sarah Muyskens and Michael Green
276 South Union Street

Burlington

Suggested Contribution*:
$250 Supporter
$100 Guest
*Space is limited, please respond as soon as possible
Please contact Carolyn Dwyer at (802) 857.5530 or
Carolyn@leahyforvermont.com with questions or to RSVP.
Paid for and authorized by Leahy for U.S. Senator Committee.
Contributions to Leahy for U.S. Senator Committee are not deductible for federal income tax purposes.

Reception for Senator Patrick Leahy

May 2nd, 2016
Yes, I will attend and support Sen. Leahys re-election with a contribution of:
$250________

$100________

Other________

No, I cannot attend but will support Sen. Leahys re-election with a contribution of $________.

Please make checks payable to:

Leahy for U.S. Senator
PO Box 1042
Montpelier, VT 05601
Please charge my personal contribution to my:
____Visa

____MC ____AMEX

Credit Card Number: ___________________________________________ Exp: _______________

Cardholders name (as it appears on card):______________________________________________
Cardholders signature: _____________________________________________________________
I designate my contribution(s) of $________ composed of personal funds, to the Committee as follows:
The first $2700 for the 2016 primary election and any additional amount I contribute, up to $2700, for
the 2016 general election.

Please Sign (required): ______________________

Federal law requires us to use our best efforts to collect and report the name, mailing address,
Occupation and name of employer of individuals whose contributions exceed $200 in an election cycle.

Name: ____________________________________________________________________________
Address: __________________________________________________________________________
City/State/Zip: _____________________________________________________________________
Employer: _____________________________Occupation:_________________________________
Home Phone: __________________________Office Phone: ________________________________
E-mail:________________________________ Fax Phone: _________________________________
Paid for and authorized by Leahy for U.S. Senator Committee.
Contributions to Leahy for U.S. Senator Committee are not deductible for federal income tax purposes.