roger williams
ROGER WILLIAMS FOR U.S. CONGRESS
q Roger,
I/we want to join you and Governor Mike Huckabee! Please accept my/our contribution of:
You’re invited to a reception honoring
ROGER WILLIAMS
m $2,500/$5,000 Individual/Couple Platinum* (Allows for entry to private host reception, photo op and signed copy of Governor Huckabee’s latest book)
RE PUBLICAN CA N DI DATE F O R U . S. CO N G R E S S TE XA S 3 3 RD DI STRI CT
m $1,000 Gold* m $500 Silver* m $250 Bronze*
WITH SPECIAL GUEST
GOVERNOR MIKE HUCKABEE
Monday, November 14, 2011 11:30am VIP Reception • 12:00pm Luncheon The Worthington Hotel 200 Main Street, Fort Worth, Texas
*Host levels above will receive special recognition at the event.
m $60 Individual Sorry, I/we cannot attend but would like to support Roger with a contribution of: ______
The favor of a reply is requested by Friday, November 11th to Kyle Jackson or Susan Lilly at 866-789-9223, by email to [email protected], or by faxing this form to 800-433-1387.
NAME(S) / ORGANIZATION
SPOUSE NAME required for joint contributions
X X SIGNATURE SPOUSE SIGNATURE required for joint contributions
ADDRESS CITY STATE ZIP
PHONE FAX EMAIL CELL PHONE
OCCUPATION* EMPLOYER*
SPOUSE OCCUPATION* SPOUSE EMPLOYER*
If contributing by credit card, please complete the following. ❒ VISA ❒ MASTERCARD ❒ AMEX
AMOUNT TO BE CHARGED $ _____________________
CARD NO. _____________________________________________________________
EXPIRATIONDATE_______________________SECURITYCODE________________________
NAME ON CARD________________________________________________________
SIGNATURE______________________________________________________________________
SPOUSE SIGNATURE IF JOINT CONTRIBUTION _______________________________________________________________________________________________________________
Please make checks payable to “Roger Williams for U.S. Congress Committee” and mail to 2340 W. Interstate 20, Suite 214; Arlington, TX 76017. Under federal law, individuals may contribute a maximum of $2,500 for the primary election and $2,500 for the general election. Couples may make contributions from a joint account, but each contributor must sign the check (or other written instrument) or a statement that accompanies the contribution. Qualified federal PACs may contribute a maximum of $5,000 for the primary election and $5,000 for the general election. Non-qualified federal PACs may contribute a maximum of $2,500 for the primary election and $2,500 for the general election. Contributions from federal government contractors and corporations are prohibited. Contributions are not deductible for federal income tax purposes. Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $200 in an election cycle.According to FEC regulations, a primary, general, special and runoff election are all considered separate election cycles with separate limits.
PAID FOR BY ROGER WILLIAMS FOR U.S. CONGRESS COMMITTEE.
q Roger,
I/we want to join you and Governor Mike Huckabee! Please accept my/our contribution of:
You’re invited to a reception honoring
ROGER WILLIAMS
m $2,500/$5,000 Individual/Couple Platinum* (Allows for entry to private host reception, photo op and signed copy of Governor Huckabee’s latest book)
RE PUBLICAN CA N DI DATE F O R U . S. CO N G R E S S TE XA S 3 3 RD DI STRI CT
m $1,000 Gold* m $500 Silver* m $250 Bronze*
WITH SPECIAL GUEST
GOVERNOR MIKE HUCKABEE
Monday, November 14, 2011 11:30am VIP Reception • 12:00pm Luncheon The Worthington Hotel 200 Main Street, Fort Worth, Texas
*Host levels above will receive special recognition at the event.
m $60 Individual Sorry, I/we cannot attend but would like to support Roger with a contribution of: ______
The favor of a reply is requested by Friday, November 11th to Kyle Jackson or Susan Lilly at 866-789-9223, by email to [email protected], or by faxing this form to 800-433-1387.
NAME(S) / ORGANIZATION
SPOUSE NAME required for joint contributions
X X SIGNATURE SPOUSE SIGNATURE required for joint contributions
ADDRESS CITY STATE ZIP
PHONE FAX EMAIL CELL PHONE
OCCUPATION* EMPLOYER*
SPOUSE OCCUPATION* SPOUSE EMPLOYER*
If contributing by credit card, please complete the following. ❒ VISA ❒ MASTERCARD ❒ AMEX
AMOUNT TO BE CHARGED $ _____________________
CARD NO. _____________________________________________________________
EXPIRATIONDATE_______________________SECURITYCODE________________________
NAME ON CARD________________________________________________________
SIGNATURE______________________________________________________________________
SPOUSE SIGNATURE IF JOINT CONTRIBUTION _______________________________________________________________________________________________________________
Please make checks payable to “Roger Williams for U.S. Congress Committee” and mail to 2340 W. Interstate 20, Suite 214; Arlington, TX 76017. Under federal law, individuals may contribute a maximum of $2,500 for the primary election and $2,500 for the general election. Couples may make contributions from a joint account, but each contributor must sign the check (or other written instrument) or a statement that accompanies the contribution. Qualified federal PACs may contribute a maximum of $5,000 for the primary election and $5,000 for the general election. Non-qualified federal PACs may contribute a maximum of $2,500 for the primary election and $2,500 for the general election. Contributions from federal government contractors and corporations are prohibited. Contributions are not deductible for federal income tax purposes. Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $200 in an election cycle.According to FEC regulations, a primary, general, special and runoff election are all considered separate election cycles with separate limits.
PAID FOR BY ROGER WILLIAMS FOR U.S. CONGRESS COMMITTEE.
