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Anne Hess & Craig Kaplan • Sarah & Victor Kovner
Tri-‐‑State Maxed-‐‑Out Women PAC
(Host Committee in formation)
Cordially invite you to a reception
With Special Guest
President Bill Clinton
In support of
Congresswoman Louise Slaughter
Ranking Member of the House Rules Committee
Co-‐‑Chair of the Congressional Arts Caucus
Wednesday, June 20th, 2012
5:30 PM – 7:00 PM
Home of Marie and Harley Lippman
Exact address provided upon RSVP
New York, NY
Please RSVP to Jackie Brot Weinberg at
(917) 699-‐‑1462 or jackie@jbwconsultingllc.com
OR
Chris Harris at (417)-‐‑861-‐‑0062 or Chris@VoteLouise.com,
Paid for and Authorized by Louise Slaughter Re-‐‑Election Committee
Louise Slaughter Re-‐‑Election Committee Contribution Form
Co-Chair: $5,000• Co-Host: $2,500 • Supporter $1,000 • Friend: $500
□ Yes, I would like to attend this event and contribute $__________
□ No, I can’t attend, but I will contribute $__________
Please make personal or PAC checks payable to
“Louise Slaughter Re-‐‑Election Committee”
Or contribute online at www.votelouise.com
Name: _______________________________________________________________________________________
Address: _____________________________________________________________________________________
City: _________________________________________ State: ____________ Zip: _________________________
Work Phone: __________________________________Home Phone: __________________________________
Cell Phone: ___________________________________ Fax: ___________________________________________
Email: _______________________________________________________________________________________
Employer: ____________________________________ Occupation: ____________________________________
Contributions to the Louise Slaughter Re-‐‑Election Committee are not tax deductible. Federal law requires political committees to report
the name, address, employer, and occupation of any individual who contributes more than $200.00 in a calendar year. Please supply this
information with your contribution. Individuals may contribute up to $ 2,500 per election, and federal multi-‐‑candidate PACs may
contribute up to $5,000 per election. Contributions from corporations, labor unions, national banks, government contractors and foreign
nationals who are not admitted for permanent residence are prohibited. All contributions must be made from personal funds and may not
be reimbursed by any other person.
Signature: _________________________________ Name (Print): _____________________________________
Louise Slaughter Re-‐‑Election Committee
1150 University Ave, Building 5
Rochester, NY 14607
TO CONTRIBUTE BY CREDIT CARD:
Please charge _______________ to my: MasterCard Visa American Express (please circle)
Name on Card: ____________________________________________________________________________________
Card Number: _______________________________________ Expiration Date: ___________ Security Code: _____
Billing Address/City/State/Zip: ______________________________________________________________________
Authorized Signature: _________________________ Second Authorized Signature __________________________
TO CONTRIBUTE ONLINE, OR TO LEARN MORE ABOUT CONGRESSWOMAN SLAUGHTER,
PLEASE VISIT WWW.VOTELOUISE.COM
Contributions or gifts to Louise Slaughter Re-‐‑Election Committee are not tax deductible.
Paid for and Authorized by Louise Slaughter Re-‐‑Election Committee
