Ohio Democratic Party 340 East Fulton Street • Columbus, Ohio 43215 • O: (614) 221-6563 • F: (614) 221-3286 2013 Ohio Democratic Women’s Caucus Convention May 18, 2013 OCSEA Worthington, OH

RSVP: ____ I would like to attend the ODWC Convention. Enclose is my contribution of $20.00 for one ticket. ____ I cannot attend but would like to support the Ohio Democratic Women’s Caucus. Enclosed is my contribution of $ ______

Your contribution will be used in connection with federals elections and is subject to the limitations and prohibitions of the Federal Election Campaign Act. We are asking for a donation of no more than $10,000 per calendar year, from individuals to the Ohio Democratic Party. We are not asking for, and will not accept for this event, contributions in excess of the federal limits, or funds from corporations, labor organizations, registered federal lobbyists, registered foreign agents, federal political action committees, minors under the age of 16, and/or any other federally prohibited sources. Federal law requires us to use our best efforts to collect and report the names, mailing address, occupation and name of employer of the individuals whose contributions exceed $200 in a calendar year.

Name(s): ______Address: ______City, State, Zip: ______Phone: ______Employer: ______Occupation: ______Signature: ______

By signing above you are agreeing with the following statements: 1) I am a citizen of the United States or permanent legal resident, 2) This contribution is not made from the treasury of an entity or person who is a federal contractor, 3) The funds I am donating are not being provided to me by another person or entity for the purpose of making this contribution. Credit Card: Check: Please make checks payable to:  Visa  MasterCard  American Express  Discover Ohio Democratic Party Exact Name on Credit Card: Please mail address to: ______Ohio Democratic Party Attn: Liz Walters Credit Card Number: 340 East Fulton Street ______Columbus, Ohio 43215 If you have any questions as to how you can Exp. Date: ______CVV Code: ______contribute, please contact Liz Walters p: (614) 221-6563 x147• f: (614) 221-0721 Signature:______e: [email protected]

Contributions or gifts to the Ohio Democratic Party are not deductible as charitable contributions for Federal income tax purposes.

Paid for and authorized by the Ohio Democratic Party, Chris Redfern, Chairman, 340 East Fulton St., Columbus, Ohio 43215. Not authorized by any federal candidate or candidate’s committee.

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