Governor Mitt Romney
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NW HOST COMMITTEE DANIELLE AND TED ACKERLEY DIANE AND CHRIS ACKERLEY GOLI AND JIM AMERI MELISSA AND STEPHEN BABSON KIM AND JOHN BRADLEY LINDA AND JOHN CARTER KATHY AND JOHN CONNORS CHRIS AND CHRIS DUDLEY ALLISON AND ROB CORNILLES GORDON EMPEY CLAYTON FONG JANINE AND JOE GONYEA, III MICHELE AND GREG GOODWIN SUSAN HUTCHISON ED INGLE HOSSEIN KHORRAM VICTORIA AND BRIAN KLEIN GREG KUBICEK DIANE TEBELIUS AND ROB MCCALLUM SUSAN AND CRAIG MCCAW CAROL AND MATT MCILWAIN CONGRESSWOMAN CATHY MCMORRIS RODGERS SHERYL AND PETER NEUPERT PATRICIA AND DAVID NIERENBERG CHRISTINE AND WAYNE PERRY TERRY AND DINO ROSSI CATHERINE MAYER AND MARTIN SELIG SENATOR GORDON SMITH GORDON SONDLAND JULIE AND PETER STOTT CHRIS WALKER KAYCEE AND TOM WIITA CORDIALLY INVITE YOU TO ATTEND A LUNCHEON RECEPTION WITH GOVERNOR MITT ROMNEY THE GOVERNOR HOTEL 4TH FLOOR 614 SOUTHWEST 11TH AVENUE PORTLAND, OREGON MONDAY, JUNE 4, 2012 NOON - VIP RECEPTION AND PHOTO OPPORTUNITY - $5,000 PER PERSON 12:15 PM - LUNCHEON RECEPTION - $2,500 PER PERSON KINDLY RSVP TO TIFFANY STARK GRABENHORST [email protected] 503-224-5489 1 Romney Victory, Inc. 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 for 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. Reply to the Luncheon Reception with Governor Romney Monday, June 4, 2012 Yes, I will be attending the June 4th 12:00 PM VIP Reception, Photo Op and Luncheon Reception with Governor Romney. Enclosed is my contribution of $ ______________ ($5,000 per person /$10,000 per couple). Yes, I will be attending the June 4th 12:15 PM Luncheon Reception with Governor Mitt Romney. Enclosed is my contribution of $ ______________ ($2,500 per person /$5,000 per couple). No, I am unable 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 Tiffany Stark Grabenhorst - PO Box 13470 – Portland, OR 97213 or Scan/Email to: [email protected] or fax the completed form to 801.443.4455 Fundraiser ID: _____________ Source (or Event) Code: _____EOR003___________ Proceeds to RV shall be allocated by the following formula: 1. Individuals and non-multicandidate PACs–The first $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 PACs–The first $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. .