Вы находитесь на странице: 1из 2

Please Save the Date

For a reception hosted by

Ali Mirza Jon Cooper

(host committee in formation)
with honored guest

Governor Martin OMalley

Thursday, June 4th, 2015
6:00 PM VIP reception
6:30 8:30 PM General reception
Home of Syed Akhter
335 Woodbury Rd.
Woodbury, NY
Co-host: $2,700 (VIP reception)
Sponsor: $1,000 (VIP reception)
Friend $500 (photoline and reception)
Ticket $150
Please make individual contributions payable to OMalley for President or
contribute online here

To RSVP and for more details, please contact

Ali Mirza at MirzaStrategies@gmail.com or (516) 457-5839
Jackie Brot Weinberg at jackie@jbwconsultingllc.com or (917) 699-1462.
Annie Osbourne at aosborne@martinomalley.com or (978) 771-1510
By Invitation Only
Paid for by OMalley for President.
Source: Sunlight Foundation's Party Time www.politicalpartytime.org. The Sunlight Foundation collects these invitations from anonymous lobbyist sources.

OMalley for President

I/We would like to attend the event on June 4th! ___
I/We would like to contribute $____________________:
To contribute by check: Please fill out the form below and make your check payable and addressed
to OMalley for President and mail to: (OMalley for President, 1501 St. Paul St, Ste. 115,
Baltimore, MD 21202)
Requested information: 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 aggregate
contributions exceed $200 in an election cycle.
Name: _________________________ E-Mail: _______________________________
Occupation: ____________________Employer: ______________________________
Address: ___________________________________________________________
City: ________________________________________ State: ______ Zip: _________
Home Phone: ___________ Work Phone: _________ Mobile Phone: ______________
To contribute by credit card: Please provide information below
and fax to (410) 849-4048, Attn: Annie Osborne.
Please charge $_________ to my: ____ Visa ____ MC ___ Amex
Name of Cardholder: ___________________________________________________
Credit Card #: _______________________ Security code: ________
Expiration Date: __________
This contribution is from a personal account: ____ Yes ____ No
Is this a contribution from a joint account? ____ Yes ____ No
If so, what is the second name on the account? _____________________________
By signing below, I certify that: I am a U.S. citizen or lawfully admitted permanent resident of the U.S; the funds I am
donating are not being provided to me by another person or entity for the purpose of making this contribution, I am not a
federal contractor; and I am at least 18 years old.

Signature: _________________________
Signature 2 (If using a joint account)*:___________________
Second Name Occupation: __________________________
Second Name Employer: ____________________________
Please contact Annie Osborne at aosborne@martinomalley.com or (978) 771-1510 with any questions.
*By signing above, both signatories agree that your contribution will be attributed equally to the names above unless
otherwise specified. Reattributions are subject to the contribution limits. Any reatrributed primary contribution that
exceeds the limits will be redesignated to the 2016 general election in accordance with 11 C.F.R. 110.1(b)(5).
Contributions or gifts to (OMalley for President) are not tax deductible. An individual may contribute up to $2,700 per
election (the primary and general are separate elections). By submitting your contribution, you agree that the first $2,700
of a contribution will be designated for the 2016 primary election, and any additional amount up to $2,700 will be
designated for the 2016 general election. By providing your phone number, you are consenting to receive calls, including
automated calls to that number from (OMalley for President).
Paid for by O Malley for President
Source: Sunlight Foundation's Party Time www.politicalpartytime.org. The Sunlight Foundation collects these invitations from anonymous lobbyist sources.