WGA’s Political Support Program LOYAL CONTRIBUTORS WALL OF FAME Annual personal contributions exceeding five years to the WGA Political Support Program Trig Solberg Trig’s since 1985 Mark Skogen since 2006 Pat Fox Fox Bros. LIFETIME since 1997 Pam Coy Viking VIllage, Inc. since 2010 CONTRIBUTORS Paul & Karen Godin Godin Personal contributions totaling more than Grocers since 1997 Greg & Kari Hansen Hansen’s IGA since 2010 $5000 over their lifetime Tim Hogan Sentry Foods Trig Solberg Trig’s Paul Nelson Nelson’s County since 1999 Jeff & Cindy Tate Tate’s Piggly Market (retired) Wiggly since 2011 Mark Skogen Festival Foods Dave SpiegelhoffSpiegelhoff Brian Conrad Conrad’s Sentry since 2000 Jeff Basting Point Foods Paul & Karen Godin Godin (retired) since 2012 Grocers Mark & Mary Stinebrink Jerry & Pat Mountin Mountin’s Stinebrink’s Piggly Wiggly Frank & Stephanie Lueptow Tom Verhagen Larry’s Markets Piggly Wiggly (retired) since 2002 Frank’s Piggly Wiggly since 2013 (retired) Mark & Mary Stinebrink Rob Webster/ Candie Baker Doug Rinehart Dick’s Fresh Terry Daniels Daniels Sentry Stinebrink’s Piggly Wiggly Webster’s Marketplace since 2005 Market since 2013 Foods Mike Coppersmith New Dave Spiegelhoff Spiegelhoff Dave Ryman CERTCO since 2006 Mark Maloney Russ Davis London Festival Foods Supermarkets Wholesale since 2014 Pam Coy Viking Village, Inc. George Prescott Prescott’s Supermarkets (retired) Carl Miller Miller & Son’s NEW levels beginning 2020! Contributors will be listed on the WGA’s website and in the WGA magazine. Special identifying name tag ribbons will be provided at WGA events. PERSONAL CONTRIBUTIONS CORPORATE CONTRIBUTIONS Century Club Personal contributions totaling $1000 or more in calendar year Platinum Corporate contributions totaling $5000 or more in calendar year. Capitol Club Personal contributions totaling $500 or more in calendar year Gold Corporate contributions totaling $2500 or more in calendar year Chairman’s Club Personal contributions totaling $250 or more in calendar year Silver Corporate contributions totaling $1000 or more in calendar year President’s Club Personal contributions totaling $100 or more in calendar year Bronze Corporate contributions totaling $500 or more in calendar year

Yes! I would like to make a personal contribution to: Yes! I would like to make a WGA Conduit Fund WGA Political Action Committee corporate contribution. PAYMENT METHOD AMOUNT OF DONATION PAYMENT METHOD AMOUNT OF DONATION

Century Club $1000 Platinum: $5000 Personal Check Personal check Corporate Check payable to WGA Political Support Program Capitol Club $500 Corporate check payable to WGA Gold: $2500 Government Affairs Program. Personal Credit Card Chairman’s Club $250 Silver: $1000 President’s Club $100 Corporate Credit Card Bronze: $500 Other ______CONTACT INFORMATION Please check this box if you do not want your name or contribution NAME NAME AS IT APPEARS ON YOUR CREDIT CARD identified in WGA publications.

ADDRESS CREDIT CARD NUMBER EXP. DATE Please return this form to: WGA Political Support Program CITY STATE ZIP SIGNATURE SECURITY CODE 10 W. Mifflin St., Ste. 205 Madison, WI 53703 PHONE FAX www.wisconsingrocers.com/contribute EMAIL