YOU ARE CORDIALLY INVITED TO A

SMALL BUSINESS AND HEALTHCARE POLICY ROUNDTABLE

ON BEHALF OF
GOVERNOR MITT ROMNEY
AND THE REPUBLICAN TEAM

WITH SPECIAL GUESTS
SCOTT ROMNEY
BROTHER OF MITT ROMNEY AND SENIOR CAMPAIGN ADVISOR
AND
MATT HOFFMANN
SENIOR HEALTHCARE POLICY ADVISOR
WEDNESDAY, AUGUST 8, 2012

WESTMOOR COUNTRY CLUB
400 S MOORLAND ROAD
BROOKFIELD, WISCONSIN





BREAKFAST $1,000 PER PERSON
HOST COMMITTEE $2,500 PER PERSON OR RAISE $10,000
EVENT CHAIR $5,000 PER PERSON

Kindly R.S.V.P. to Richard Walters at 857.288.3837 or 601.316.7022 / rwalters@mittromney.com

Romney Victory, Inc.
c/o Kirstin Hopkins
Post Office Box 149757
Boston, MA 02114-9757

Contributions to Romney Victory, Inc. ('RV) are not tax deductible for federal income tax purposes. RV is a joint
fundraising committee composed of Romney Ior President, Inc. ('RFP), the Republican National Committee ('RNC),
the official Republican Parties in four states (the Idaho Republican Party, the Massachusetts Republican Party, the
Oklahoma Leadership Council, and the Vermont Republican Federal Election Committee), the National Republican
Senatorial Committee ('NRSC), and the National Republican Congressional Committee ('NRCC).


Paid for by Romney Victory, Inc., a joint fundraising committee authorized by and composed of Romney for President, Inc., the
Republican National Committee, the Idaho Republican Party, the Massachusetts Republican Party, the Oklahoma Leadership
Council, the Vermont Republican Federal Election Committee, the National Republican Senatorial Committee, and the National
Republican Congressional Committee.

7:30 AM
HOST COMMITTEE AND EVENT CHAIR
PRIVATE MEETING
8:00 AM
BREAKFAST
ROUNDTABLE
Source: Sunlight Foundation's Party Time www.politicalpartytime.org. The Sunlight Foundation collects these invitations from anonymous lobbyist sources.



Breakfast Roundtable
Wednesday, August 8, 2012


REPLY INFO
Yes, I will attend the Breakfast Roundtable. Enclosed is my contribution of $ _________ ($1,000 per person).
Yes, I will join the Host Committee and pledge to raise $10,000 or give $2,500. Enclosed is my contribution of
$_________ and I pledge to raise $_________.
Yes, I will attend the Host Committee Private Meeting and Breakfast Roundtable as an Event Chair. Enclosed is
my contribution of $_________ ($5,000 per person).
No, I am unable to attend, but enclosed is a contribution of $________________.

Please make your check payable to: Romney Victory, 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_______________________________________________________________________

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 collect and report the name, mailing address, occupation, and name of employer of each contributor whose contributions
aggregate in excess of $200 in a calendar year (RNC and state parties) or election cycle (RFP). Please complete the following:

Occupation__________________________________________ Employer________________________________________________

Joint Contributor Occupation___________________________ Joint Contributor Employer____________________________________

CREDIT CARD REPLY
Please charge my contribution of $________to my credit card. Visa MasterCard AMEX Discover

Account Number___________________________________________ Expiration Date____________________________________

Name on Card____________________________Signature________________________________________________________

Mail to: Romney Victory, Inc.
c/o Kirstin Hopkins PO Box 149757 Boston, MA 02114-9757
Phone: 857.288.3837 Secure Fax: 781-930-5422 Email to: rwalters@mittromney.com
Fundraiser ID: 208000 Source (or Event) Code: EWI007
Proceeds to RV shall be allocated by the following formula:
1. Individuals and non-multicandidate PACsThe Iirst $2,500 will go to RFP`s primary account. The next $2,500 will go to RFP`s
general account. The next $30,800 will go to the RNC. The remaining amount will be split evenly among the federal accounts of the
Republican Parties of Idaho, Massachusetts, Oklahoma, and Vermont, up to a maximum of $10,000 per committee.

2. Multicandidate PACsThe Iirst $5,000 will go to RFP`s primary account. The next $5,000 will go to RFP`s general
account. The next $15,000 will go to the RNC. The remaining amount will be split evenly among the federal accounts of the
Republican Parties of Idaho, Massachusetts, Oklahoma, and Vermont, up to a maximum of $5,000 per committee.
Notwithstanding this allocation formula, a contributor may designate a contribution for a specific participant or participants.
In addition, the allocation formula may change if any contribution would exceed applicable contribution limits. Contributions
from corporations, labor unions, federal contractors, and foreign nationals are prohibited. Federal law requires us to collect
and report the name, mailing address, occupation, and name of employer of each contributor whose contributions aggregate
in excess of $200 in a calendar year (RNC and state parties) or election cycle (RFP).


Paid for by Romney Victory, Inc., a joint fundraising committee authorized by and composed of Romney for President, Inc., the Republican
National Committee, the Idaho Republican Party, the Massachusetts Republican Party, the Oklahoma Leadership Council, the Vermont
Republican Federal Election Committee, the National Republican Senatorial Committee, and the National Republican Congressional Committee.

Source: Sunlight Foundation's Party Time www.politicalpartytime.org. The Sunlight Foundation collects these invitations from anonymous lobbyist sources.