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Cordially Invite You to Join Maggies List for a Private Reception Featuring

The Honorable Nan Hayworth


Candidate for U.S. Congress (NY-19)

TUESDAY, SEPTEMBER 17, 2013 6:00 p.m. 7:30 p.m. HOME OF THE HONORABLE GEORGETTE MOSBACHER 1020 Fifth Avenue (entrance at 83rd Street) New York, NY
Platinum Host: $5,000 (raise or contribute) Event Host: $2,500 (raise or contribute) Individual: $500 / Young Professional: $250 RSVP to Alexandra at info@sentinelstrategic.com or (202) 680-8840
Paid for by Maggies List and not authorized by any candidate or candidates committee. www.maggieslist.org - 6675 Weeping Willow Way Tallahassee, FL 32311

Please make check(s) payable to:

MAGGIES LIST
6675 Weeping Willow Way Tallahassee, FL 32311 If you have any questions, please contact Alexandra at info@sentinelstrategic.com or (202) 680-8840. YES, I will attend the Maggies List Private Reception at the following level: $5,000 Platinum Host (Includes Annual Maggies List Governor Membership Benefits) $2,500 Event Host $500 Individual $250 Young Professional Individual NO, I will be unable to attend the Maggies List Reception. However, enclosed is my contribution in the amount of $ _________________ to support Maggies Lists efforts.
CONTRIBUTOR INFORMATION: Full Name ____________________________________________________________________________________ Address ______________________________________________________________________________________ City _________________________________________________ State _______________ Zip_________________ Mobile Phone _________________________________ Work Phone _____________________________________ E-mail _______________________________________________________________________________________ We are required by law to ask for the following information: Occupation ___________________________________ Employer _______________________________________ All contributions to Maggies List must be personal. Corporate contributions cannot be accepted. Please make check(s) payable to Maggies List or you may contribute online at www.maggieslist.org/contribute.php CREDIT CARD REPLY: For your protection, the address you provide must be the same as the billing address of your credit card. Please charge my contribution of $___________ to my credit card. Circle one: Visa MasterCard AMEX Discover

Card Number _________________________________________ Exp. Date ___________ Security Code ________ Name on Card ________________________________________________________________________________ Signature _____________________________________________________________________________________ I certify that I am a United States citizen, that this is not a corporate contribution and that my contribution will not allow me to go over my PAC contribution limit per the Federal Election Commission of $5,000 per calendar year. Contributions to Maggie's List are not tax deductible. Federal Election Law requires Maggie's List to report the name, mailing address, occupation and employer for each individual whose contributions aggregate in excess of $200 in a calendar year.

Paid for by Maggies List and not authorized by any candidate or candidates committee. www.maggieslist.org - 6675 Weeping Willow Way Tallahassee, FL 32311

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