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DC Dental PAC
cordially invites you to attend a reception with Organized Dentistrys friend in the US Congress

Congressman Paul Gosar

In support of his re-election campaign for U.S. Congress Tuesday, January 14, 2014 5:15 6:00PM Prior to Januarys DCDS monthly meeting Westin Georgetown 2350 M Street NW Reception attendance minimum contribution $100 RSVP by Friday, January 10th For questions, please contact DC Dental Society 202-547-7613 or info@dcdental.org Gene Giannini 202-244-4111 or eugene@smiledc.com

Please See Contribution Form Attached

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

Paul Gosar for Congress Contribution Form

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Congressman Gosar, I am proud and honored to join you on Tuesday, January 14th to support your re-election campaign for U.S. Congress. I am enclosing my most generous contribution in the amount of: $5,200 $2,600 $1,000 $500 $250 $100 Other $ _________

Unfortunately, I am unable to participate but am enclosing a contribution in the amount of: $_______________ For contributions to both the primary and general election funds, individuals may contribute up to $5,200; Couples up to $10,400; PACS up to $10,000. Please make checks payable to: Gosar for Congress Checks may be mailed to DCDental PAC 502 C Street NW Washington DC 20002 To contribute by personal credit card, please complete the following: Please circle one: Visa MasterCard American Express Discover Amount: $______________________ Name on card: _______________________________________________________________________________ Card #: ____________________________________________ Security Code: _________ Exp. Date: ________

My signature verifies that this contribution represents my personal funds and is not drawn on an account maintained by an incorporated entity or other prohibited source.

Signature of Contributor: _____________________________________________________________________

We are required to report the name, address, occupation and employer of those who contribute more than $200 in an election cycle. Please complete below.

Full Name: _________________________________________________________________________________ Spouses Name (if joint):________________________ Spouses Sig. (if joint): __________________________ Employer: _____________________________________ Occupation: _________________________________ Spouses Employer (if joint): ______________________ Spouses Occupation (if joint): __________________ Address: _______________________________________________ City: _______________________________ State: ______________________ Zip: __________________________ Fax: ____________________________ Home Phone: ________________________________ Work Phone: _________________________________ Email: ______________________________________ Mobile Phone: _____________________________

Contributions to Gosar for Congress are not deductible as charitable contributions for federal income tax purposes. An individual may contribute up to $2,600 for the primary election and up to $2,600 for the general election. Federal multicandidate PACs may contribute up to $5,000 for each election. Contributions from corporations, labor unions, federal-government contractors, and foreign nationals (non-green-card holders) are prohibited. *Federal law requires Gosar for Congresss best efforts to obtain, maintain, and report the name, address, occupation, and employer of any individual who contributes more than $200 in an election cycle.

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