YOU ARE CORDIALLY INVITED TO A

RECEPTION
WITH

ANN ROMNEY
MONDAY, OCTOBER 15, 2012 4:30 P.M. THE HILTON
ONE NORTH 2ND STREET HARRISBURG, PA 17101
GENERAL RECEPTION
$1,000 PER COUPLE $5,000 CONTRIBUTION PER COUPLE OR RAISE $15,000 $15,000 CONTRIBUTION PER COUPLE OR RAISE $50,000
FOR MORE INFORMATION, PLEASE CONTACT: ANDY DAVIS, ADAVIS@MITTROMNEY.COM, 857.288.3831

VIP RECEPTION AND PHOTO OP PRIVATE DINNER

Please make contributions payable to Romney Victory, Inc.

c/o Andy Davis P.O Box 149757 Boston, MA 02114-9757 Contributions to Romney Victory, Inc. (RV) are not tax deductible for federal income tax purposes. RV is a joint fundraising committee composed of Romney for President, Inc. (RFP), the Republican National Committee (RNC), the official Republican Parties in four states (the Idaho Republican Party, the Massachusetts Republican Party, the Oklahoma Leadership Council, and the Vermont Republican Federal Election Committee), the National Republican Senatorial Committee (NRSC), and the National Republican Congressional Committee (NRCC). Paid for by Romney Victory, Inc., a joint fundraising committee authorized by and composed of Romney for President, Inc., the Republican National Committee, the Idaho Republican Party, the Massachusetts Republican Party, the Oklahoma Leadership Council, the Vermont Republican Federal Election Committee, the National Republican Senatorial Committee, and the National Republican Congressional Committee.

Source: Sunlight Foundation's Party Time www.politicalpartytime.org. The Sunlight Foundation collects these invitations from anonymous lobbyist sources.

Harrisburg Reception Monday, October 15, 2012 REPLY INFO Yes, I/we will attend the General Reception. Enclosed is my contribution of $_______________ ($1,000 per couple). Yes, I/we will attend the General Reception and VIP Photo Reception. ___Enclosed is my contribution of $__________________ ($5,000 per couple). ___I pledge to raise $15,000 Yes, I/we will attend the General Reception, VIP Photo Reception, and Dinner. ___Enclosed is my contribution of $__________________ ($15,000 per couple). ___I pledge to raise $50,000 Yes, I/we will be on the Host Committee for the October 15th event and pledge to raise $_______________ ($15,000 per person). Yes, I/we will be a Co-chair of the October 15th event and pledge to raise $_______________ ($50,000 per person). Please make your check payable to: Romney Victory, Inc. Name_________________________________________________________________________________________ Address_______________________________________________________________________________________ City____________________________________State______________________Zip__________________________ Home Phone____________________________________ Work Phone___________________________________ E-mail________________________________________________________________________________________ CONTRIBUTOR INFO This contribution is made by check or credit card from my personal funds and is not drawn on an account maintained by an incorporated entity. I am a U.S. citizen or permanent resident and this contribution will not be reimbursed by another person. Signature_______________________________________________________________________ For a contribution from a joint account to be attributed to two individuals, both must sign this form, indicating agreement with the above statement. Joint Contributor Signature_________________________________________________________ Federal law requires us to collect and report the name, mailing address, occupation, and name of employer of each contributor whose contributions aggregate in excess of $200 in a calendar year (RNC and state parties) or election cycle (RFP). Please complete the following: Occupation__________________________________________ Joint Contributor Occupation___________________________ Employer______________________________________ Joint Contributor Employer_______________________

CREDIT CARD REPLY Please charge my contribution of $___________ to my credit card. Visa Account Number___________________________________________

MasterCard

AMEX

Discover

Expiration Date___________________________

Name on Card____________________________Signature____________________________________________________ Mail to: FINANCE c/o Andy Davis PO Box 149757, Boston, MA 02114 Or Fax: 781-930-5422 or Scan/Email to: adavis@mittromney.com

Fundraiser ID: _____9629____ Source (or Event) Code: ___EPA019___ Proceeds to RV shall be allocated by the following formula: 1) Individuals and non-multicandidate PACs - The first $2,500 will go to RFPs general account. Prior to August 31, 2012, the next $2,500 will go to RFPs primary account. Beginning on August 31, 2012, should Romney for President have primary debt, that next $2,500 will go to RFPs primary debt retirement account. The next $30,800 will go to the RNC. The remaining amount will be split evenly among the federal accounts of the Republican Parties of Idaho, Massachusetts, Oklahoma, and Vermont, up to a maximum of $10,000 per committee. 2) Multicandidate PACs - The first $5,000 will go to RFPs general account. Prior to August 31, 2012, the next $5,000 will go to RFPs primary account. Beginning on August 31, 2012, should Romney for President have primary debt, that next $5,000 will go to RFPs primary debt retirement account. The next $15,000 will go to the RNC. The remaining amount will be split evenly among the federal accounts of the Republican Parties of Idaho, Massachusetts, Oklahoma, and Vermont, up to a maximum of $5,000 per committee. Notwithstanding this allocation formula, a contributor may designate a contribution for a specific participant or participants. In addition, the allocation formula may change if RFPs primary account receives sufficient funds to retire its outstanding primary debt or if any contribution would exceed applicable contribution limits. Contributions from corporations, labor unions, federal contractors, and foreign nationals are prohibited. Federal law requires us to collect and report the name, mailing address, occupation, and name of employer of each contributor whose contributions aggregate in excess of $200 in a calendar year (RNC and state parties) or election cycle (RFP). Paid for by Romney Victory, Inc., a joint fundraising committee authorized by and composed of Romney for President, Inc., the Republican National Committee, the Idaho Republican Party, the Massachusetts Republican Party, the Oklahoma Leadership Council, the Vermont Republican Federal Election Committee, the National Republican Senatorial Committee, and the National Republican Congressional Committee.
Source: Sunlight Foundation's Party Time www.politicalpartytime.org. The Sunlight Foundation collects these invitations from anonymous lobbyist sources.