Please Join Us

Camille Cooper, Lanette Phillips, Danny Lockwood, Doug

Champion, Scott Malzahn, Alice Lynn, Brian Chase, Rick Lynch,
Carmen Lynch, Eric Barrett & Nancy Lee Grahn

Invite you to a
Private Cocktail Reception
honoring

Governor Tim Kaine

To benefit his campaign for U.S Senate

Thursday, May 26th

7:00pm

At the home of Scott Hackwith & Lanette Phillips

1131 Embury St.
Pacific Palisades, CA 90272
 Suggested Contribution Levels
$1000 Benefactor $150 Supporter
Donations - http://kaineforva.com/pp
For more information or to RSVP please contact 310-801-
0001, lanettephillips@gmail.com or
david.brooks@kaineforva.com
Contributions or gifts to Kaine for Virginia are not tax deductible as charitable
contributions.

Paid For By Kaine for Virginia.

Kaine for Virginia

May 26th Cocktail Reception

_____ Yes, I/we would like to attend the Reception as a benefactor and
contribute $1,000.00

_____ Yes, I/we would like to attend the Reception as a sponsor and
contribute $150.00

_____ No, I/we are not able to attend, please accept a contribution of $
_________

Please make your contribution payable to “Kaine for Virginia” and mail to:

Kaine for Virginia

PO Box 12307

Richmond, VA 23241

Contributions to Kaine for Virginia 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 Kaine for Virginia 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 Kaine for Virginia are not tax deductible as charitable
contributions.
5.26.11LA2

Paid For By Kaine for Virginia.