Reps. Steve Israel, John Larson, Chris Van Hollen, Jim Clyburn, Sandy Levin, Pete Stark, Jim McDermott, John Lewis, Joe Crowley, Emanuel Cleaver, Charles Gonzalez, Jose Serrano, Ed Pastor, Carolyn Maloney, Jan Schakowsky, G.K. Butterfield, Gregory Meeks, Nita Lowey, Sheila Jackson-Lee, Barbara Lee, Eddie Bernice Johnson, Donna Edwards, Frederica Wilson, Rob Andrews, Corrine Brown, Bennie Thompson, Chaka Fattah, Karen Bass, Terri Sewell, Shelley Berkley, Steve Cohen, Lois Capps, Jim McGovern, Jim Langevin, Elijah Cummings, Bill Pascrell, Brad Sherman, Mike Capuano, Bobby Scott, Richard Neal, Mike Thompson, Pedro Pierluisi (list in formation) Cordially Invite You to a Birthday Reception for Charlie Rangel Chairman Emeritus, House Ways and Means Committee Democratic Candidate for Congress, 13th Dist. of New York Wednesday, June 20, 2012 @ 6:00 pm Hosts: Honorable Dick Gephardt, Honorable Martin Frost, Honorable Alan Wheat, John Jameson, David W. Jones, Vincent Eng, Sudafi Henry, Chuck Brain, Thomas Kim, William Oldaker, Rosa Whitaker, Bill Signer, Ken Bowler, Alex St. James, Rob Leonard, Javier Llano, Steve Bailey, Florence W. Prioleau, Dan Moldonado, Bernie McKay, Michael Williams, Brian Moran, Bob McGlotten, Erin Graefe, Mike McKay, John Raffaelli, Jon Talisman, Jamie Harrison, Jon Sheiner, Jim Arbury, Stu Eizenstat, Larry Thompson (list in formation) At the Home of John Jameson 616 North Carolina Ave SE Washington, DC 20003 Individual: $250, PAC: $500 Young Professional (under 30): $100 Host: Individual (write or raise), $1,000 PAC $2,500 Please RSVP by emailing Jackson Barnett at firstname.lastname@example.org or calling 941-268-6481 Paid for and Authorized by Rangel for Congress. Printed In-House Rangel for Congress June 20th Reception PLEASE 1) Go online and make your contribution at www.charlierangel.org (preferred), 2) FAX this form to 212-862-4845, or 3) Send your check payable to “Rangel for Congress” to: Rangel for Congress P.O. Box 5577 Manhattanville Station New York, NY 10027 _____ Yes, I/we would like to attend the reception, enclosed is my contribution of $________ _____ No, I/we are not able to attend, please accept a contribution of $ _________ Contributions to Rangel for Congress are limited to $5,000 per individual ($2,500 for the primary election and $2,500 for the general election) and federal multi-candidate PACs may contribute $10,000 ($5,000 for the primary election and $5,000 for the general election). A husband and wife may contribute $10,000 ($5,000 each) by one check drawn from a joint account and signed by both individuals. Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and name of employer for individuals whose contributions exceed $200 in an election cycle. If this is a contribution from a husband and wife by one check drawn from a joint account and signed by both individuals, please provide the requested information below for both individuals. Name: ______________________________________________________________________ Mailing Address:_______________________________________________________________ City: __________________________________ State: _____________ Zip Code:___________ Occupation: ___________________________ Employer: _______________________________ Home Phone: __________________________ Work Phone: _____________________________ Fax: __________________________________ Cell Phone: ______________________________ Email: ________________________________________________________________________ If you prefer to pay by credit card, please complete the following: Credit Card Type: _____ Visa _____ MasterCard _____ Name on card: ____________________________________________________ Amount: _________ Billing Address (if different): ____________________________________________________________ Card Number: _______________________________________ Exp. Date: ________ Code:_________ YOU MUST ALSO SIGN BELOW Federal law prohibits contributions to Rangel for Congress from corporations, labor organizations and national banks; from any person contributing another person's funds; from foreign nationals who lack permanent resident status; and from federal government contractors. By signing below, I affirm that my contribution is from personal funds and not from funds otherwise prohibited under law. Contributor Signature (REQUIRED): ________________________________________________________________________________ Contributions or gifts to Rangel for Congress are not tax deductible as charitable contributions. Paid for and Authorized by Rangel for Congress. Printed In-House.