ROGER WILLIAMS FOR U.S.

CONGRESS

www.rogerforcongress.com

Wayne Lott and Maripat & Judge Jim Powers invite you to a reception honoring

THURSDAY, JULY 26, 2012 6:00pm 7:30pm

HOST LEVELS

ROGER WILLIAMS
REP UBL ICAN CA N DI DATE F O R U . S. CO N G R E S S TEXA S 2 5 TH DI STRI CT

m $1,000 Platinum* m $500 Gold* m $250 Silver*

*Host levels will receive special recognition at the event.

COACH BOB KNIGHT

HALL OF FAME BASKETBALL COACH

With special guest

m $50 Individual
Elected officials please contact Judge Powers at 512-858-1317 for more details.

At the home of Maripat & Judge Jim Powers 1280 Drifting Wind Run Dripping Springs, Texas 78620

m Sorry, I/we cannot attend but would like to support

Roger with a contribution of: ______

The favor of a reply is requested by Wednesday, July 25 to Kyle Jackson or Susan Lilly at 512-477-7722, by email to kyle@lillyandcompany.com, or by faxing this form to 800-433-1387.

NAME(S) / ORGANIZATION X SIGNATURE ADDRESS PHONE EMAIL OCCUPATION* SPOUSE OCCUPATION*

SPOUSE NAME required for joint contributions X SPOUSE SIGNATURE required for joint contributions CITY FAX CELL PHONE EMPLOYER* SPOUSE EMPLOYER* STATE ZIP

If contributing by credit card, please complete the following. VISA MASTERCARD AMEX
CARD NO. _____________________________________________________________ NAME ON CARD________________________________________________________

AMOUNT TO BE CHARGED $ ____________________

EXPIRATIONDATE_______________________SECURITYCODE________________________ SIGNATURE______________________________________________________________________

SPOUSE SIGNATURE IF JOINT CONTRIBUTION _____________________________________________________________________________________________________

Checks may be made payable to Roger Williams for U.S. Congress and mailed to P.O. Box 1504, Austin, Texas 78767.
Under federal law, individuals may contribute a maximum of $2,500 for the run-off election and $2,500 for the general election. Couples may make contributions from a joint account, but each contributor must sign the check (or other written instrument) or a statement that accompanies the contribution. Qualified federal PACs may contribute a maximum of $5,000 for the run-off election and $5,000 for the general election. Non-qualified federal PACs may contribute a maximum of $2,500 for the run-off election and $2,500 for the general election. Contributions from federal government contractors and corporations are prohibited. Contributions are not deductible for federal income tax purposes. Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $200 in an election cycle. According to FEC regulations, a primary, general, special and run-off election are all considered separate election cycles with separate limits.

PAID FOR BY ROGER WILLIAMS FOR U.S. CONGRESS COMMITTEE.