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Sunday, March 25, 2012

6:00 p.m. – 7:30 p.m.

Paid for by Stabenow for US Senate

 Yes! I will attend as a Sponsor ($500 per Sponsor). Please reserve _____ tickets.

 Yes! I will attend as a Guest ($100 per Guest). Please reserve _____ tickets.

 I cannot attend, but would like to support Senator Stabenow with a contribution of $_______.

Name _____________________________________Address ___________________________________

City/State/Zip ________________________________________________________________________

Employer__________________________________ Occupation ________________________________

Home Phone _______________________________ Office Phone ______________________________

Email: ___________________________________________Fax: _______________________________

Signature: ___________________________________________________________________________

Contributions or gifts to Stabenow for U.S. Senate are not tax deductible. We may accept contributions from an individual

totaling up to $2,500 per election cycle (primary and general). Federal law prohibits contributions to the campaign 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 above, you affirm that

your contribution is from personal funds and not from funds otherwise prohibited under law.

If this contribution is from more than one individual, such as from a wife and hu*****and, please provide the requested

information and signature for each. If two signatures are provided, you both affirm that your contribution is made from a joint

account. To comply with federal law, we must use best efforts to obtain, maintain and submit the name, mailing address,

occupation and name of employer for individuals whose contributions exceed $200 per election cycle.